Insurance & Financing

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

Has anyone had the 6 mth supervised weight loss plan waived? Dr says I am a good candidate for that..he is writing a letter to them and advised my to call and writer them also. Had anyone ever done this successfully? What did you say in your letter or conversation?

Jumping for joy! Just found out I've been approved by Tricare North! After many days of biting my nails the email came today! Now on to the next stage of life;))))

Got approved

Okay so just got word that i have been denied for the 4th time...Bah humbug!! this time around i wrote my own personal letter to my insurance greivance dept. I asked them to reconsider their answer and also supplied more info on the req 6 month supervision that they previously have said there wasnt sufficient info on and i was going off the basis that my dr had resubmitted my bmi at 40. Originally my dr's office submitted all my paperwork at 39 bmi with hperlipidemia but that didnt qualify according to my insurance. So, my dr's office said they resubmitted my bmi as 40 and that would make me qualify. Well insurance is saying that nothing was ever submitted showing a…

My paperwork for VSG was submitted last week and I am a nervous wreck. I can't focus on ANYTHING. I have Generalized Anxiety Disorder (with a "specialty") in catastrophic thinking, so I'm always thinking the worst. I need a reality check, which is why I've come to you all! Below are the requirements for obesity surgery with United Healthcare under AT&T's plan. I meet all of them. Yet, I can't help thinking that they are going to deny me. Covered Person must have a minimum BMI of 40; • Covered Person must have documentation of a diagnosis of morbid obesity for a minimum of five (5) years from a Physician; • Covered Person must be 18 years or older; and • Surge…

Hi im new to this site i, have finished all of Cigna requirements, still worried they will deny...anyone having problems getting approve by cigna?

Hi All, Has anyone in this forum has the sleeve with empire blue cross *** insurance in NYC recently I would like to know how much was or Copay for the procedure I have to have a Hernia repaired. if anyone else has or had this same situation your response will be greatly appreciated. I'm worried my insurance will not cover me and I can not be out of pocket In my insurance card it states that my copay is $1,000 for hospital stay but now I'm wondering if I have to pay more than that

Hi. Im new to this site and I have a few questions. I live in Nashville Tennessee and I'm wondering if medicaid will cover a VSG surgery for me. Im diagnosed morbidly obese. Im 5'5" and 400 pounds. Im on Lisinopril for blood pressure, Lexapro for anxiety, Metformin for Insulin Resistance (thats right before full blown diabetes), I have arthritis in my knees and ankles and trouble getting around, and I suffer from nasty migraines. I've also been having trouble getting enough breath. I always seem to be panting as if Im out of breath, even when I dont do anything. I just moved here, but my doctor in Virginia had me on several different things over the last 3 years. Alli, Se…

Anyone have any idea how long I will have to wait To get approval from my insurance company? I submitted everything they asked for yesterday and was hoping someone can give me an estimate of how long it takes for blue cross blue shield to make a decision.

When I did the pre-op, then registration the day of my surgery, I was told I had nothing to pay other than my co-pay. Yesterday I had a letter from my insurance company saying that I owe the Dr $4,308.45 (the amount they wouldn't cover). The hospital/Dr charged my insurance over $82,000 for my lapband but insurance would only cover a little over $76,000. Of course neither my insurance nor dr's office is open on the weekends. Talk about shocking mail!! (I do have my pre-op paper work that says "method of payment for surgery... " and cost of surgery "$0"

Hello!!! I am new to the forum and have a question about Aetna approval for the six month track. On Monday I finished my last weigh in at my doctors office. I called my surgeons insurance coordinator to tell her I was all done and was ready for her to submit my information. She then informed me that I was required to have a psych eval. Now, I have read the bulletin a million times for the physician requirements and no where does it state the psych eval as a requirement. It does state it though for the multidisciplinary track which is only 3 months. I told her I called Aetna and they said I did not require it, but she claims they are telling her I need it. I am really get…

so, I've met all the criteria that the barbaric surgeon gave me to qualify for lap band. I have a BMI of 37.5, high blood pressure, and sleep apnea. I also had a family history of obesity, heart disease and diabetes. the only requirement I have not met is having 3 years of weigh ins with a primary care physician. I am worried that for this reason, emblem will deny me, but I can't find anywhere on emblems website that states that this is an actual requirement..? has anyone encountered this problem with emblem? will this cause me a problem? is 3 years of weigh ins an actual requirement?

I had to move my surgery up a couple of weeks to accomadate my job and I have about another week until I'm done with my testing but my surgery is May 15th so I just was wondering what the average time is it takes to get insurance approval?

Well boo-hoo, just found out my insurance won't pay! What a disappointment.; Now to figure out if I really want to shell out $10,000 for the surgery. I know my health is more important than $, but that's a big chunk of change to let go of even if you have it! :/ Lots of soul searching to be done this weekend!

I have a question about Tricare. I have all my doctors and test done but my physicians weight loss documentation goes back to 2005 to date. It is not consecutive because the medications given is not for long term use. Would they deny me based off this or do they look for documentation that the program has been done? I also have documentation since November with my updated weight loss program? All of this is very confusing because it seems people get approved and denied based off the smallest wording or mistakes in documentation. Ive been waiting now over a week and starting to get nervous... Grrrrr

Hey Sleever's, I have been lurking for awhile and just researching the procedure. I had the talk with my PCP today about VSG and he actually preformed bariatric surgery back in the '80s. He was telling me how different it was back then to today. However, something came up in my blood work that I need to see a specialist about (hormone levels) and wanted me to do so before the surgery. Then I got the call from Dr. Black's (surgeon) office on my insurance for the surgery. I have the normal requirements: - 6 month supervised diet - Psych Eval - Nutritionist My main concern was the cost. My insurance (Blue Cross of California) lists it under General Surgery so it is…

I am currently in my 3rd month of my pre-op diet (for insurance purposes) and may be moving out of state before I hit the six month mark. I am concerned that transferring doctors may cause insurance to deny me. Has anyone experienced this or know what will happen? Ugh, worried...

Well my ins approved me in about 9 days...im sooo excited, got my medical clearance from my pcp...just waiting for this ulcer to heal!

I posted another thread on this a while back when I was awaiting the decision from Cigna on my first appeal... well, that appeal was denied...on the basis of me "not providing documentation of a physician supervised 6-month weight loss program." Funny thing about that is, I DID! My doctor's office even kept records of what they sent, and it was part of the packet. In fact, I waited to resubmit my appeal until my 6-month program was completed and documented. After going round and round in circles with literally dozens of Cigna people, my doctor's office got a fax number of someone in appeals who was willing to look at just the "missing information." So, they faxed it ove…

Ok, this is my first time on this site. Love it so far! I have gone to nutrition consult and am on week 4 of my 3 month physician supervised diet. I have my psych eval. On April 16. I am wondering about other peoples experience with federal bc/bs insurance and their approval process. I am so scared that I. Am not going to be approved. Is their a weight loss that they want to see for 3 month diet? My BMI is 48. I have high blood pressure only, no other co-morbidities. How long did it take to get approval after office submitted info? What did you say for your letter as to why you wanted this surgery? Do u talk about personal reasons or give facts about benefits of losing w…

Hello I have some major venting to do!!!!! I was scheduled for surgery 4/17. I thought I had all my paperwork in order.... Turns out I was misled by my primary physician. I have been in process since October of this 2011. I called to get the requirements from my insurance company and was told amongst other things I need a 6 month documented history of weigh ins and consultation with my primary. After month 2 my doc said no need to schedule appt I can just come in and weigh. Well long story short I needed 6months worth of appointments. This pushes my surgery date forward to August 8-/. In addition I'm in the mist of switching employers and have no information on if the sur…

I went to info session this evening. Super discouraged and wish I hadn't even gone. Found out today my employer has an "obesity exclusion" on our BCBS of AL policy. The surgeon's office where I attended the seminar advised me they have no financing options and they don't accept Care Credit. A clinic in neighboring state does. I'm still considering the Mexico option, even though my bf & bestie both have a fit when I mention it. I am terrified of the debt w/Care Credit but just as terrified of diabetes, heart trouble, joint replacement, etc (all of which would be covered by my policy). I have some savings, but definitely not anywhere near $15K. Ughhh.... Any suggest…

Does anyone know if you can pay off your Care Credit balance early and not have a penalty? For example, if I finance 5000 over 36 months & then 3 months later I have enough cash elsewhere to pay it all off, would I just be able to pay the remaining balance of the 5000? Or would I owe 6238 (the total amount I would have paid CareCredit over the life of the loan)? Sent from my iPhone

Does anyone know how long for their approval ?? Thanks you

Hi everyone!!! So on 4/21 is my last nutritionist appointment and on 4/27 I have my first of 2 psychological evaluations. Now I have a question about insurance. Right now I'm currently on Vermont state health insurance and I already know that it covers lap band surgery. Now my husband just started a new job as an over the road truck driver last month. On July 1st I am covered under his insurance which I believe is Blue Cross Blue Shield. Does anyone know if I would have to redo EVERYTHING in order for them to cover my surgery? I hope not. I'm hoping to have my surgery before my insurance switches but I don't know how fast everything will go. Thanks

Got denied on my first try I did everything that I needed to do they said if I feel I was wrongly denied write a letter proving my case I'm so sad and feel helpless I'm way over 40 BMI I have health issue and I done six month of a weight plan can anyone help

I'm am a 20 year old girl. I have been waiting to get this surgery for about a year now. I planed on having it in December or January while I was on school break but my insurance denied it. My surgeon put together a appeal for me, I have a lot of things wrong with me that would go away of I lost weight. I've been trying for years but I just can't lose it. So we put in the appeal right away and they are still deliberating. It has been so long and I feel like this is my only hope. I don't know what to do. Do you think they will approve it? My surgeon said she has never lost and appeal.

Anyone had surgery done by Dr. Gonzalez in Texas? Hoping to have surgery.

I was told by my surgeon that Empire just started 6 month ago to approve the Sleeve as a lose weight option has anyone gone through these insurance did they cause any trouble to approve the surgery?? and what where the requirements to be approved???

I have bcbs ca. Do most all bcbs plans cover the sleeve? Does anyone have the medical code for the sleeve procedure? I guess I just assumed it was covered, but now I'm getting a little nervous.

Ma so excited to share tht today I was approved for the vertical sleeve!!! Overall this process was a lot quicker than expectednt only too me about 6 weeks, from seminar to approval, to get approval! My insurance is bcbsnc and I am thrilled that this process was as simple as it was its time for me to sit on the losers bench!

I guess i am really getting nervous because my paper work will be submitted to my insurance Friday i have cigna..anyone denied because of weight gain while on the six month supervised diet??

I just got approved and I am soooo scared. Before the approval there was nothing but excitement from my first appointment 9/30/11. I think that I honestly thought I wouldn't get approved because I'm 26 and 248. However, they approved me very qucikly and my surgery is the 25th. All I keep thinking about is.... what if something happens to me? I am too young to die. I have a 1 year old son.... what if something goes wrong???? Maybe I am just having thoughts like this because I buried my grandmother yesterday and my boss died last week, but what are the statistics? What are my chances? Am I willing to die for this? Am I crazy because I am going through trauma in my l…

My paperwork should have been submitted today, now I'm obsessing about hearing back! How long did it take for you to get your approval?

I just found out my insurance is going to cover my lap band surgery as well as any after care including fills and abdominal skin removal when I get to goal weight. I am super re leaved that they aren't going to make me do a whole list of things before they will cover me, all I need is my PCP and surgeons to write a referral letter! I am withing 2-4 months from having my surgery depending on when my dietary, psychiatric and physical activity appointments happen! Wish me luck!

Extremely frustrating situation and I need to vent about it!! My surgery is scheduled for May 15th and I've been going through my 6 months with the nutritionist and getting my testing done but this weekend I got a letter from my insurance company saying my doc is not a participating physician with my plan and saying we owed over $700 to the doctor for one visit. I am only 18 so my mom was the one that talked to the office about surgery officially but they told her they take our insurance. The doctor even works out of the hospital that my parents work at and that my insurance is through and many other people my mom knows in the hospital have gotten the surgery through this…

Im so nervous. I finished everything and got my surgery datę. Just waiting on aetna approval .. My surgery is supposed to be in 2 1/2 weeks in syosset hospital in ny

When i went to have surgery in Feburary of 2010, I was expecting to be self pay, but it turns out BCBS of Florida with my plan in particular covered the lap Band. Awesome! But they required a 6 month waiting period. Crap! When I first submitted all my information to the insurance company in January of 2010, I also included photo copies of my weekly weight watchers weigh in's theat showed a 6 month history of trying to lose weight. I also contacted my General Practitioners office and have them send my entire medical fil to my Lap band surgeon, so they could go through and pull out all the info from my file that dealt with my weight (the different medications i trie…

I have Health Net *** right now, but am thinking of switching to the PPO verision in May during open enrollment. My problem is that my PCP won't refer me to have weight loss surgery, specifically Lap Band. Can anyone help me with a Health Net *** or PPO physican in Los Angeles County that would be willing to refer me? Thank you for your help. Monisha

I went to the surgeon's office a couple weeks ago to start my 3 month diet with the nutritionist. She asked me a few questions and then asked me if I was firm on the August date. I told her I could do the surgery as soon as the insurance approves me. She then said you can have your surgery as soon as your 3 month diet is completed and scheduled a surgery date. I'm just wondering if this is common. I have Federal BCBS and my BMI is 55.

My surgery is the 17th and the paperwork was sent over the insurance for approval 1 week ago and still waiting. So nervous

here is what I got off the Tricare page today: Bariatric Surgery TRICARE will cost share any of the following open or laparoscopic bariatric surgical procedures: Roux-en-Y gastric bypass Vertical banded gastroplasty Gastroplasty (stomach stapling) Adjustable gastric banding (i.e., adjustable LAP-BAND®) If you meet all of the following conditions: You're at least 18 years old or you provide documentation of completion of bone growth. You were unsuccessful with non-surgical medical treatments for obesity. Your medical records must show your failed attempts. Diet programs, such as Weight Watchers®* and Jenny Craig*, are acceptable methods of dietary ma…

O.k. I have Tricare Prime and see a civilian pcm. She is on board with me getting a vsg. She submitted a referral to tricare for me to have a vsg done at an mtf. Tricare denied the first one so she has submitted another a different way. Still waiting to hear. Can anyone please tell me how to get this done.... My mtf (Ft. Benning, Ga.) doesn't do the surgery so I am trying to go to Fort Gordon, Ga about 4hrs away. Does anyone know how to get this done. Tricare tells me they don't have anything to do with an MTF and the MTF tells me that the referral has to go thru Tricare. I am so frustrated and upset as this is going on 3 weeks of going in circles to get no where. My husb…

So I have been lurking around the forums for months now, and now that I am coming close to surgery I thought I would ask a few questions. I had my final nutrition appointment yesterday (6 month required for insurance), and my case worker submitted my information to UHC this afternoon. I got a call about an hour ago from my insurance company letting me know that they have approved my surgery!! I called my case worker and she said that was the fastest she has ever received an approval (less than 2 hours after submission). To give some background for comparison, I am 29 years old (BMI 51) and have no co-morbities at all. I don't even have high blood pressure, the surgery i…

I have to submit proof that I was involved in a non-surgical weight management program for at least 6 consecutive months in the last year. I have already gotten proof from Weight Watchers of my payment for 6 consecutive months in 2011. What I don't have though is a record of my weight. I'm looking for some opions from anyone that has BCBS and had to submit similar proofs. Did you have to submit proof of your weight at each meeting or was record of your payment for 6 consecutive months enough? Thanks!

Hey everyone. My insurance said they do not cover the lapband. How do I get them to approve it? Any tips on secrets or anything I can do? Oh and I have BCBS of FL

Hi All- I am lucky enough to have great insurance, but they require a 6 month diet/fitness at a location that I just can't do. So, I decided to go ahead and self pay. Ugh. 20k here in Seattle. When my surgeon did the endoscopy, he found a hiatal hernia that he's also going to repair. I talked to my insurance company to see if they'd cover the hernia repair that was being done at the same time. They told me they'd cover that, plus the anesthesia, hospital room, etc - anything related to hernia repair. Whoo hoo! Right? I called the surgeon back and the insurance person there says it's still 20k, that they will bill my insurance for the hernia repair but it doesn't chan…

One of the criteria for insurance covering me is: The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery. Anyone know what do they mean by these efforts must be fully appraised by the physician requesting authorization? Thanks!

Hey Everyone, About a week ago, I was denied by Highmark BCBS for the sleeve based on it not being medically necessary and appropriate. My BMI is 36.4 with associated Hypertension and Type 2 Diabetes Mellitus. My surgeon did a peer-to-peer review this week but got no where with the physician on the review committee. Based on the fact that the peer review didnt make any progress, what are the chances that my appeal letter will have the denial overturned? I am kind of bummed because I think my chances are not so good now. Thanks Lisa