Insurance & Financing

Does anyone have Blue Cross Blue Shield out of Ca? If so, what were your requirements? Do you have to have a pcp? Also, how long did approval take?

My insurance is requiring 3 years of doctors records indicating that I have been over BMI of 40 for at least 3 years. I do not have records from 2009 so the insurance specialist at docs office told me to submit pictures from 09 and a personal letter as to why I don't have records for that year. ( my Mom was dying of cancer that whole year and passed away early 2010) has anyone ever done this and gotten approved? I'm starting to get worried that they won't approve it. Do they actually sit down and read these letters? Any thoughts or suggestions? Thanks - Kelly

So, my surgery was approved, and I was scheduled to have my procedure on the 9th of April 2012. Well, yesterday I received a phone call stating that I'll have to bring $4500 in order to receive services. I was completely devastated. I literally cried myself to sleep. Throughout this entire process, the fact that I'd have to come out of pocket for anything but my remaining deductible ($1500) was never mentioned. I have United Healthcare, Choice Plus, and they've implemented a Bariatric Resource Service program that covers expenses associated with the surgery, yet I still have to come out of my pocket $3000 and it doesn't make sense why. I've tried calling for additional in…

Spoke to my coordinator Linda on Thursday and she said that Dr. Garcia no longer has in house financing. She said the company bolted last Monday and she just found out. I don't know what to do now because I can't get traditional financing. So any suggestions anyone. I'm so disappointed. I had already been approved from my job for time off. Anyone know of a good surgeon that does in house financing ? Plllllleeeeeeeezzzzz help me!

This is one of the companies that Dr. Aceves office recommends. I applied online with them. Gave them ALL of my financial and private information. This was over three weeks ago. They have not responded to my emails or answered their phones. I am pissed off to say the least. DO NOT apply with them and expect anything except for frustration. I am so mad that they have all of this information on me. I told Nina at Dr. Aceves office and they kind of blew it off. Don't get me wrong, I do love their CS thus far at Dr. Aceves office but I do think they need to be mroe aware of the crappy company that they are recommending to their patients.

Anyone have the Medicare Advantage Ins thru UHC/Sec Hor AARP? Were you approved or denied quickly? My paperwork was submitted on March 28th, so now its sit & wait after working like crazy to jump thru hoops, ummm make appts & tests. I'm anxious, nervous, & antsy. I'm not much in the way of patience for things like this. I have a BMI of nearly 60 with 4 co-mor issues, so I cant think of a thing I can get turned down on, but knowing insurance companies as I do, they will probably find a reason............sigh.......... Could do with some good news Roni

Hello! Is anyone familiar with bcbs anthem of Cali? My insurance coordinator just faxed in paper work, just wondering how long will it take for approval? Super anxious...can't wait to start my new life...

I'm looking for some good surgeons in the US who offer a reasonable self-pay option. Mexico is not an option. I have found a few out there that seem to have a good following. Just looking for any help. I prefer to have a Dr. on the East Coast since I'm in PA. Thanks

I found out yesterday that my company will be closing the division I work for by May 28th, and I will be losing my job as well as my insurance. There will be a transition, so some people will be let go sooner, but there are no specific dates, so we don't know who will go before that, or who will be here 'till the end. I got my lapband 9/15/11, and am still getting fills every month as I'm not feeling any restriction at all. I've got 6.5cc in a 14cc band, so there is still plenty of room to go. My surgeon charges a lot of money for a fill (it's over $600 for the appt. and the fill) - but my insurance paid for most of it - my cost was only $41 after I met my deductib…

Looking to have VSG and am paying cash. Mexico prices are enticing but is Mexico safe in 2011? Need info on safest locations or reasonable providers in the United States more specifically North Carolina.

I called my insurance company this morning to check on my case and they told me I was denied. The reason - a BMI of 39.6 with no comorbidities. I am really confused as to why my BMI was listed at 39.6 as the doctor said I had a 41 BMI. Even with that, I still can't believe they denied me because of 4 pounds! Ridiculous! I am waiting for a call back from my doctor's office to discuss this. I am pretty sure they are going to act all confused as they always are. The front office is so incompetent! I am thinking of going the cash route but with a different doctor. This doctor doesn't deserve my money after working with them for 6 months and having nothing but issue…

Hello, I was wondering opinions on getting the extra insurance to cover slip, erosion, port problems for self pay patients. My doctor offers this and wondered if others had this or thought good idea. My biggest fear is landing back in hospital for a complication and not covered.so leaning towards it if good idea. Also I'll look up statistics but anyone know current statistics on these issues in the first two years or if they occur are they happening later then 1 or 2 years?

I have BCBS of TX. My handbook states the following: Benefits for Morbid Obesity Benefits for Eligible Expenses incurred by Participant for the Medically Necessary treatment of Morbid Obesity will be provided on the same basis as for any other sickness. This is all it say about Morbid Obesity. Do you think I will have to go through the 6 months of supervised diet. I hope not. I am so ready to have this surgery. I am so ready to be healthy. Anyone else have BCBS of Texas? If so, any information you could share would be appreciated. Thanks Dina

I was so close to get my sleeve surgery. I was working and had insurance. I was just going to send the paper work, but I injured myself at work now I'm going with some legal process but I no longer have insurance. So now I'm looking for a good doctor but not to expensive. The doctor I had was going to charge me 18900. I can't afford it. Can somebody recommend me a good doctor that doesn't charge to much Now I'm just sad cause I was really exited to have my sleeve. I was Sooo close to have it.please any suggestion or recommendations. Thank you guys!!

Has anyone been approved through crescent insurance? My mother is pursuing getting sleeved and her insurance isn't looking to promising in paying... Any tips or advise??? TIA!!

Hi, I was wondering if anyone had done an External Review through UHC? I was denied twice and then they go to a third party external review if you appeal again which I did. I thought it might actually be better to have an outside party review as I did not think UHC was reading my companies policy (the one published to employees) correctly. UHC received 2/15/12 which they have 30 days but then the external company got it 2/29/12 (not sure why so long) and they send a letter saying they have 45 days. I called to see if it typically takes that long as Dr. office is pressing for whether going insurance or self pay. UHC did not know and but something in their system…

Can I be denied if I don't lose or gain weight during the diet?

Hi everyone I have tricare prime west region iv been through the whole process already once before and i got denied this was before they just changed there policy as of 10-5-11 where now they arnt using the 100lb over weight or 200% rule.... they are now going by a bmi of 40 + without a co morb or 35-39.9 with a co morb ..... I am about a 40 with no DOCUMENTED co morbs but I also have heard now they are making you do a medically documented weightloss program weight watchers or jenny craig etc. I heard it was a 6 month program that had to be documented but when i looked in there policy they dont state a time frame or 3 or 6 months .... im just curious if anyone has been ap…

Trying to think if I should get my stuff together (since I have completed all pre-op requirements) and have the clinic submit my items for Tricare approval (without the 6 month dr visits completed). (I have done 2 of the 4 PCD visits).. As Tricare stated they did not need me to wait 6 months..but clinic is saying that Tricare does.. any thoughts...

I have Triwest, I wonder if it will change our benefits once United Healthcare takes over? More-so, I wonder if they'll cover VSG?

anyone ever have any experience with Horizon BC/BS insurance mine is a direct access which i dont know if that matters. But submitted to insurance a few weeks ago with a march 13th surgery date. Last wed dr office told me they wanted a copy of my psy evaulation which i dont understand why that wasnt sent with all my other clearances. And they also wanted a detailed letter as to what i have been doing about weighloss for the past year. which we sent immediately. Called dr office on thursday afternoon and told to stop worrying . now im sitting here with 10 days left and what should i think.. seriously am i going to be denied with only a few days left when my dream could be …

I just got denied a 3rd time! I dont know what i want to do at this point. Im angry sad confused! Finally emotionally drained at the thought of appealing on my own behalf, which insurance said i could do. I called the drs office and told them i would like to come by and pick up all the documents that were submitted. They told me they will have to put everything together and will call me next week when its ready. Wait, why isnt it ready now?! Wth?! Didnt they just resubmit my info this week?! I dont get it!! I started at 39 bmi now im 40 bmi so i dont need the comorbids and my dr office states that the 40bmi is what was submitted this past week for the dr on dr revie…

The Sagamore criteria for lap band is: diagnosis of morbid obesity, 40% BMI , or twice your IBW. I am 35% BMI and have 3 comorbidities. Dr has not submitted the predetermination yet. Is it likely to get approved? Opinions, suggestions, or advice needed. Thanks in advance!

Criteria for insurance is a BMI of 40% or that you wegh twice your IBW &. have a diagnosis of morbid obesity. No mention of obesity related disorders. My BMI is 35% and I have diabetes, high cholesterol, and obstructive sleep apnea. Also, the my blood pressure, gets a little bit higher every month. Any advice on getting my insurance to approve me for lap band surgery?

Hello I'm new here. I'm on my 6 month of the diet supervision and I go talk to the nutriticuist today at 3:30 and then to the psychological service on the 26th. Can anyone give me some helpful news about bcbs of al. I have high blood pressure and a mid sleep- disorder

My wife is about to sign up for her new insurace now that it is open enrollment time. We are both looking to get Lap Band and was wondering if anyone could answer a few question for us. So far she has gotten only a small amount of info regarding her options (basically a 5 page print out of information so far). On the print out it says: Gastric or Intestinal Bypass Maximum benefit per lifetime: 1 also on another page it states: Morbid Obesity Treatment 1) If it states 1 under benefits per lifetime..does that mean only 1 of us would be able to get it..or does it mean 1 per person? 2) What would Modbid Obesity Treatment cover..as in how is it differnt from Gas…

My paper work was sent in today. I am so hoping to hear something back from them soon! getting excited now!!!! did everyone who has bcbs of illinois have good luck w/ them?

Had my last appointment yesterday and they are submitting the paperwork. If UHC replies back in a timely manner I could have surgery on March 27th!!! I'm nervous yet excited. Hope I get approved. Do I wait for them to call me or should I call after a certain amount of time?. Also anyone who has UHC how long did your approval take? Thanks!

I want to know your approval wait time. Anyone with any medicaid affiliated insurances?

i am new to this, so whats does it mean when they say u have to meet ur deductable from ur insurance is that like paying off a bill or something because i tried to pay my full deductable but i didnt have an account therefore i couldnt pay it and im only at 475 i need to reach 3000. but i do have a hospital bill for 700 so if i pay that will that go toward my deductable..

I started this process 2 years ago but stopped because I didn't care for the Dr. that I chose. I started again in November with Dr. Hanna in Las Vegas and I am so happy! At the end of the month I am done with my 3 months supervised diet (was able to use the months from the previous try for a total of 6) so the Dr office sent off my redetermination on monday to Aetna and I got approved this morning!!! Woo Hoo!!! My surgery is scheduled for April 18th..I am sooo excited :-)

I have tricare prime north and i am wondering does tricare also pay for the fills? (my surgery will be in july due to my clinic saying i have to wait 6 months supervised dr visit).

Just curious what other people have had to pay. I was under the impression I had a $200 deductible and the rest was covered but so far they are saying I owe $330 and they arent done processing...

So I have been lurking on this forum for a while. I have 1 month left to go on my 6 consecutive doctors appointments. Already have my psych eval, blood work,EKG, and chest X-ray. My first appointment with the surgeon is April 10th after that all I will need is my nutrition class. Then they will send for approval with my insurance, they said most probably I will have a surgery date sometime near the first of May! My question is this for my insurance to cover the sleeve I need a bmi of at least 50 my bmi is 49.9! Doctors office did not tell me to gain weight however they did say the bmi is calculated on your first appointment with the surgeon. So do I gain the weight? Put r…

I called my insurance company (Anthem BCBS) yesteday and was told I had coverage for LB surgery. The guy told me that once my deductible and copays are met (which they will be because of another surgery), the LB would be covered at 100% by them and I'd owe nothing. Well, I called back today because I was trying to get additional information and now am being told they will only pay 50% of it and it isn't subject to my deductible and out of pocket maximum. I told the girl of my conversation yesterday and she is going to check further and call me back but she is pretty sure I was given wrong information yesterday. If I have to pay half, there is no way I can afford this…

We have a tussle with our insurance company, Medical Mutual of Ohio, every time we get an operation. They always balk at paying for the anesthesia. When my wife had roux n y they refused, then said ok. When I had my gall bladder out the same, and now they are refusing to pay the anesthesia for my sleeve. They are saying the anesthesia people at the hospital are not submitting the proper paperwork but it makes me nervous to be on the hook for $2,600. I'm a tough guy but I don't think I could have just bit on a stick while Dr. Lalor cut me, blew me up with air, stapled and cut and sewed me up. Even my machismo has it's limits.

My Dr.'s Office have submitted my paperwork... Excited & nervous but ready to move on to the next step... Surgery!!! Does anyone know how long this process normally take?

Unfortunately, I am without healthcare coverage, and the only way I can have WLS is to get financing. Can anyone tell me their actual experience with eMedical Financing Solutions? What about CareCredit? I heard that MedLoanFinance.com is a scam, so I need to check out financing resources carefully. Of course, their websites paint "perfect" pictures, so I need much more info than is given on their websites. How much in financing $$$ can you request? Appreciate any help on finding answers.

Is the medical code for the lap band 43770?

I have been working with Medicalfinance.com for a month now. My surgery is scheduled for next Friday the 23rd and I was called today and notified that the company that was financing my loan closed thier doors. REALLY?? Just like that? The verification process is worse than being approved to by a house. I even got a call from the loan company verifiying information from my husband and I the day before yesterday. What the heck???

Hi everyone, me again, Hello Nurse. Just another way to help all those such as myself who need to count their pennies! FSA! It's the way to go I get reimbursed for everything I pay for. All medicines, all Doctor co pays, tests, lab work, Protein powders, if it's for treatment for Obesity, it qualifies. As long as Doctor writes a prescription for it. Even my $500 co pay for the surgery!! If you are able to sign up thru your employer, I suggest it. The maximum I can save is $2,500/ year. They take put a certain amount from each pay check( pre tax dollars) then put it an FSA account. I then fax in a claim with proof, and my money is reimbursed back to me via direct depo…

Hi Sleevers! I was wondering if anyone has used Aflac. If so, how long did your claim take and if you don't mind sharing, how much!! I have had my Hospital Indemnity Policy since 2003, time to get the duck to help me out, Ha I also habe the Short Term Disability since 2008. Gonna try to work " Quacky"  Im a single Mom and I own my house, Im always trying to make ends meet, every bit helps!! Sent from my iPhone using VST

Hi everyone! I am fairly new to this forum and finally decided to make a post! I was originally planning on having lapband surgery and have now decided that I am going to go through with the sleeve instead. I have learned so much through this forum and really appreciate how much information everyone gives!! Anyways, to my topic... So I recently was informed that I was allowed to use either Weight Watchers or Jenny Craig as proof of completing a 6 month supervised diet as long as it was within the last 2 years. I did have my stamps from Weight watchers for April of 2010 through September 2010 which thank god came out to exactly 6 months. The question I had is one o…

My initial request was denied by my insurance (BMI lower than 50) & the peer2peer did nothing. My surgeon’s office suggested switching to an insurance that covers the sleeve. I’m not sure how I go about this or how it even would work. Anyone else ever hear or even attempt to do this. I’m fully aware the premium will be outrageous, but it’s better than paying $20k out of pocket.

I have BCBS TX (I have a high deductible policy) with a $1000 deductible & then they cover 70%. I don't really have a lot of hoops to jump through, I just had to do a psych eval. My ins & Dr's office are kind of wishy washy about this. They are asking for $1000 up front (expected) but I am trying to figure out how much this will cost me after everything is said and done. I know I will owe 30% of all charges beyond that as well as my $150 hospital. I am just trying to gauge this before hand. I am pretty versed in ins (kid with med issues) & I have had the shock of opening bills months after a surgery and just not know what I was getting myself into.

Can I get feedback on eMedical Financing Solutions and MedLoanFinance.com. I've been looking for customer reviews, but haven't found many. Are there any reputable financing brokers that you can recommend for individuals who must self-pay and don't have insurance. Thanks.

I FINALLY got the call from my surgeons office today that I was approved!!!! They do believe in hitting it close. My surgery is March 20. I was gonna fall to pieces if I had to reschedule. It took them exactly 26 days from submittal to approval.

I applied for a loan with them and got accepted by one of the six loan companies.. but it's outragous.. I can't beleve anyone would ever accept a loan like this.. it was for 4900 payments 243/month for 4 years.. over the life of the loan you'd pay more than double the amount.. that is crazy ridiculous.. They say if i have co-signer i maybe able to get a better deal.. I just wondered if anyone has gone with this company? At that rate i may just go to my local credit union and see about a loan there.

Well I just mailed off my 2nd appeal letter. This one to the external appeals place or independence review organization not sure what the "technical" name is for it. I am SO NERVOUS!! If they deny me this time I don't know what I'll do as this is the end of the insurance road & self pay is not an option at this point in my life.

Whats the difference? I was told I was by insurance i was approved but now I have to wait for predtermination & preautheration?