Insurance & Financing

APPROVED, APPROVED!! I'm still in shock.... My drs office called EMPIRE BCBS today to let me know she was submitting my paper work, she told me they asked her a few questions and approved her over the phone in minutes!!! I'm still in shock! I was so shocked and in dienail that I had to call BCBS myself and they said YES, its approved! 100% .. I love Empire BCBS - Thanks you! I have a BMI of 41 and nothing else I totally assumed it was going to be a long journey for me but it was not. I'm so greatful. My surgery date is March 6th. I started my Journey on Jan 21! This is so unreal! Thank you everyone for your support and feedback over the last two weeks …

I started the process January 13, 2011 and I have a surgery date of March 9, 2011. Empire BCBS approved me in less than 24 hours and I got a phone call frm them 5 minutes after my doctors office called and told me I had been approved. No unreasonable request... psych clearance, letter of medical necessity, bmi 35 with a comorbidity or 40 without, 1 nutritional consult, labs EKG...that's it 5 things! Very impressed, simply because because insurance can be a nightmare. Get a good doctor, make friendly with the office staff, smile a lot and tell them thank you, it goes a long, long way! sshhh Empire BCBS is the bomb!:Banane33: my happy dance. Good Luck to all.

My paper work will be ready to go on Feb 10th! My last consult is Feb 9th in the drs office and they told me they will send it out on the 10th. I have a BMI of 42.1 I have my phy test, My letter of medical necessity, all my meeting I needed etc. The only thing I don't have is proof of weight history. I never been to a pcp until this year. Looking at Empire BCBS requirements I don't see that I need this but i'm still stressing can someone with this INS please tell me if you needed it and or can someone look at there policy ( attached) and tell me your reading the same as me and I don't need it?? I do have WW but no weights just proof I pay monthly since 2007! …

I just recieved a letter from my doctor stating that Regence BCBS doesn't cover the lapband but does cover Laparoscopic bypass only. Has anybody else ran into this?

I am new to this forum and I just wanted to post my story so that it may help someone else. I started my lapband process in March of 2011 my BMI was 38 with comorbities. When I started this process I had Hypertension being treated with medication. Gerd-on medication,High Cholesteral. My insurance denied Lapband surgery due to not meeting there qualifications under there policy. First Denial came in and at that point I talked with my office insurance gal instructed me that you can appeal but you can't appeal with the same information as first submission and also said I can have Lindstrom Healthcare Advocay look at my file and see if they can help with getting it appr…

I am scheduled for surgery on August 30th. I am a medicaid patient, and here is my question for anyone out there who might have an answer. It took me a very long time to get approved, and my insurance approval is good for 6 months, from June 2011 to Dec. 2011, and I was told that medicaid will pay for fills. However, I was told by another medicaid patient that there were restrictions on how many fills they would pay for, and that in the event you wanted the band removed, they would not pay for it, unless you have proof your health is at risk. Does anyone know if this is true.

So I was sent to insurance for approval on Monday and found out today it was denied because they are saying the original referral didnt come from my primary care doctor. WELL IT DID.... Tricare decided to change my primary doctor today and now has denied the referral. So now I am in the process of switching back to my primary doctor who did the referral and hoping that this will all be behind me on tomorrow....... THIS SUXXXXXXX

Hi Folks! I'm new to the forum. I just finished doing my pre-approval process with Carewise for BC/BS of Illinois. I was told today by Carewise that their medical director had determined that I met all of the criteria for surgery and they were sending my file to BC/BS IL today. DOes anyone know how long it usually takes to get an answer after going through the Carewise process first? I've been told by Carewise that I should have my approval letter in 1-2 weeks. Has anyone been denied at this point, and how long does it really take? Just and FYI - I've done the physician supervised diet, had all my consults, psych eval, etc. I had to do all of that to get the approval …

Hey everyone, I just sent in the last bit of information asked for by my insurance which is United Health Care (Choice Plus) and I was wondering about how long it took for you to get approved (or denied)? Thanks

Good afternoon, I had a friend that did not know the policy has changed that she no longer needed the 6 month supervised weight requirement. She is so happy and will be in surgergy less than 2 weeks. If this apply to you please contact your doctor. I am posting information from Blue Cross Blue Shield webiste: Title: Bariatric Surgery Number: SUR716.003 Effective Date: 02-01-2012 Legislation: ILLINOIS: None NEW Mexico: None OKLAHOMA: None TEXAS: None FEDERAL (applies to all Plans): None Contract: Each benefit plan, summary plan description or contract de…

So after all the hassle of the pre-op appointments my insurance apparently doesn't require a pre-cert or authorization! My surgeon's office said they have never had that happen. The coordinator even asked me to call my insurance to double check. Nope, they don't require any pre-certs for ANYTHING. Not for surgery, hospital admissions, MRIs, nothing. I also made sure that the procedure is covered by giving them that code. It is so I now have a date. Just curious if anyone has experienced this with their insurance? I know that usually people are trying to fight to get it approved so this is weird!

Just came out of surgeon app, Out of pocket is 12,750!!! ouch!

Had a question about Weight Watchers. I was just notified by my insurance that I can substitute my 6 month Physician supervised diet with either Jenny Craig, Weight Watchers, etc. (minimum 6 consecutive months within the past 2 years) However, I was wondering if anyone has found a way to retrieve this kind of information from weight watchers. I called the 1-800 number, but all they were able to supply me with was the billing information on how many months I paid. (Which I know will not be sufficient since I am positive they will want to see my weight at that time.) I know I just saw my little "Weight Watchers Weight Tracker book" somewhere in my house not too long…

On 11/16 my papers were submitted for review with BCBS Today on 12/2 I was approved!!! Took 2.5 weeks. I tried soooo hard not to think about it while I was waiting. I have weight to lose b4 surgery and that's my last hurdle. I'm so exited I'm out of breath but I figured bcbs people might like to know the approximate wait time. cheers!

So I was approved for my surgery following a long year of denial letters and appeals. I am approved to have it before July, When I first started this journey I was 260+ but since then Ive lost to about 235 (A lot has to do with stress from school and not eating). I have my surgery scheduled for March 1st and based on my bmi now Im at 40.5 On the document 40 is the lowest bmi so if I do the doctors pre op Protein diet and lose more weight could they still deny me the day of the surgery if my bmi is lower than 40???? Any experiences, recommendations, or advice I would greatly appreciate. Im pulling my hair our over here worrying.

Went today for my 1st Dr. visit, was super excited. I had already contacted my insurance and found out that I'm covered at 95%. My meeting went great, was advised of everything I had been reading about in this forum, 6 months with a dietitian, psych review, etc. But the kicker is after all that and reviewing my current health, was told my BMI was too low at 37??? I don't have a diagnosis of anything, except for GERD and a hernia. So now I have to start a process with my primary card Dr. to see if anything has changed and I can get a diagnosis of sleep apnea or diabetes, or something. It just stinks so bad, I mean what happens if health wise I don't get any other dia…

Well i have gone through my 6 months of supervised visits and did all the other necessary tasks for my insurance company's (Highmark BCBS) requirements to be consired for the surgery. All of this was completed back on Nov 1st 2011and i'm STILL waiting for approval! ARGH. Well i should say i was denied within 1 weeks time the first go round (Dec 12th or something like that) on the basis that my dr. did not submit a more complete review of my 6 month supervision. He sent in a summarized version of it and apparently that is not enough. Well it took about 1-2 weeks for that to get resubmitted and now i have been waiting for an answer ever since. Each time i call my ins…

Does my ins Empire BCBS pretty much say as long as the physician agrees its a go? I have all my tests done my bmi is 42.2, I have letter of medical necessity , phy eval, nusring nutritiousness, etc. The only thing I DONT have is weight records. I never been to a pcp. Is Empire BCBS not asking for this? could this be correct? Could it be that easy? Please read and give me your feedback. Thanks everyone!! I'm so annoying I know but so stressing. My paper will be submitted on the 10th after my final nursing program. forgot the link http://www.empireblu..._pw_a053317.htm

I was so excited to get the call yesterday that I was approved for my surgery on 10/11! And I was so happy with the whole process. My insurance has always been GHI - CBP for City of NY Employees. Years ago I had looked into getting the surgery, but they didn't cover it at all then. Now they do (for a few years I believe). Anyway, there requirements are BMI of 40 or 35 with a co-morbidity. Also the 6 month thing and psych evaluation. Mine was 40.2 and I had 2 co-morbidites - sleep apnea and osteoarthritis (which not every insurance company accepts, but they do). Originally my doctors office said they had to schedule surgery in order to submit it to the insurance company…

I was curious as to who else had unites healthcare through the railroad? If so how hard was approval and about how long did it take?

Anyone have the surgery in Mississippi?? If so how much did it cost? If not in ms how muc was it where ur from?

So my story in a nut shell is, I had the band done in 09 while i was with Blue Cross.It took a short amount of time to get approved, like less then a month. I lost about 35 pounds. Then gained it all back by the first year in a half. Now im with United Health Care and im waiting for them to approve me to change the band to the sleeve. The reason being is that my band slipped and the adjustments didnt work because of that. so i was wondering if you know anyone who has my current insurance and is awaiting approval for the surgery, or was waiting.. and how long did they wait for? did they have to pay a certain amount? did they have to take classes before surgery?? any inf…

My last test is Feb 9th and my doctors office said she will mail/fax my paperwork over on the10th!! I have not been to a pcp ever! Since I was a child so the only letter I got from a pcp is the recent one stating why I need this surgery. I have a BMI of 42.1 and I'm 38. What was your turn around time with BCBS? I was able to provided everything but pcp notes of prior WL. I can't stop wondering what will happen and will be devastated if this does not get approved. My surgeons office already put me in for a Feb 21st surgery. They seem to feel it won't be an issue at all. Thanks all!

Anyone out there with BCBS of Illinois through Local One? I'm just wondering what hoops you had to jump through.

I got my lapband almost exactly five years ago. I was self pay so did not need to jump through the insurance hoops to prove that it was medically necessary for me to have it although I could have if I had insurance at the time. I wasn't employed but I had come into some money so I could afford to do it self pay. A wonderful thing so I thought at the time. Now my lapband has eroded and I need to have it removed but my insurance is giving me the run around trying to say that I got it for "cosmetic" reasons. I guess if an insurance company doesn't give their blessing that it is medically necessary then they assume that it wasn't. Anyway, I was just wondering if anyon…

I have tricare insurance and went to my last appoinment today!!! The doctors office says they will be submitting no later than monday for approval. How long does this process usually take for tricare patients??? Super excited and ready to start my journey.....

Ok, I have done 4 of my 7 weigh ins...still need to do nutritionist appt, psych evalution, and sleep apnea...my question is at what point does the drs office normally submit to insurance to try for approval. My 7th weigh in will be mid-late April...my deductable started over June 1. Wondering what the odds will be to get band in that 5 week window. Thanks, Karie

Just found out my group insurance with my employer has an exclusion for bariatric surgery. The insurance specialist at the doctors office I chose called on my behalf and found out that surgery is covered if deemed medically necessary. She was advised by to send in my hight, weight, and BMI for a "Precertifiation". This seemed very scant but she was advised this was all the info that was needed. My BMI is 40 on the dot. Has anyone else had experience with this "Precertification" process?? It will take 3 weeks to get an answer back. My nerves are wrecked!

Hi, I'm looking at self pay and set up a giveforward page but was wondering if there was any other ways that people set up fundraising for surgery. http://www.giveforwa...lapbandforkelli I was wondering if anyone else had done this and had any success? Thanks in advance for the advice or help.

Today I recieved a letter of denial from my insurance company I went through the entire pre-op and I had all the qualifications; BMI more than 40, medical problems etc. I am so sad and upset at the same time. I was afraid this was going to happen.

Okay, I'm new to Tricare. Really new. My coverage doesn't even start until March 1st. I've already attended a seminar though... and the doctor their said he takes Tricare (though he didn't think Tricare payed anything for the surgury yet, silly guy). Anyways, I need to know how you do this. Can I call the surgeon direct. Do I need to see a physician first? Does Tricare assign me a physician or do I get to pick one? HELP! :biggrin:

So I recently found out that my insurance does not cover any sort of weight management issues (jerks!), including bariatric surgery. I am still very interested in having the Lap Band procedure, and am considering doing the self pay option (even though it's SO expensive!!) I live in Stamford, CT, and have been working with the Stamford hospital (a great team) but I have been informed that the self pay cost is $16, 500, and since my insurance doesn't cover the surgery, they also recommend taking out a separate insurance policy for $1,500 in the event of surgery complications, which comes to a grand total of $18,000. I have read a few other forums from people in the southern…

I just want to share my frustration with the processing of my insurance claims following my vsg surgery. First of all, I have jumped through all the hoops required of insurance: 40+ BMI to start Documented weight loss attempts 5% weight loss during 6 month pre-op Nutritionist appointments Psychiatric appointments Diet doctor appointments Blood tests to prove I am a non-smoker Received a letter of medical necessity approving the surgeon and hospital prior to scheduling the surgery. To my knowledge, I am the first one to have this surgery covered by my husband's insurance. Bariatric surgery is newly covered, but not "treatment for obesity". They have initiall…

Okay, so you know Im counting down until I get to see my surgeon. I have also thought about the possibility of not being approved or a long weight time with my insurance. I have an aunt that has good insurance, and was wondering if I wanted to switch to hers (assuming they allowed the surgery of course) how long would I have to be insured with her insurance to be approved? Would it be a wait time? Would I even be able to be on hers? I do not know how insurance works. Btw shes insured via her job. Is it only a spouse thing? Thanks.

Cigna's requirements state a BMI of 40 and above requires no co-morbidities. This is what they say......but Im wondering if they really mean it. I was tested extensively last year and everything came out normal. My BMI is now 40 on the dot. It would be horrible to go through the 6 month time frame and be denied because of such. Has anyone been approved by Cigna with no other health issues found??

So....my plan requires that I have a 3 month supervised diet (since I don't have any comorbtalities) and documented BMI equal to or greater than 50 "at least one month preceding surgery". Does this mean we can document my 51.1 BMI at my first appointment and then go through the 3 month diet without fear of being denied? Thanks for your help!!! Sara

I'd like to know how much is insurance monthly for a person with one or two people? I tried googling it, and have came up with so many different answers and usually the companies want you to call and speak with them. They ask you questions first, instead of the straight answer. I want to know because I'm still waiting to see the doctor towards the end of the month, and I am not sure how long the wait for surgery might be with my current insurance, but I have an idea it will be six months, could be a year. I currently have a Health Plus. The last figure I saw online was something like 400 a month for one person, or something like that.

I just got my approval from Cigna on my first try! I am so excited, I can't wait to meet with the surgeon and set the date.

I am hoping someone can help me with this or has an experience to share.... I am posting this in the MX forum also... I have set aside $7500 in FSA funds (Flex Dollars) for my surgery in MX with Dr. Rodriguez. So, I called my insurance company (United HealthCare) to discuss what i will need to submit a claim if my card doesnt work in MX. Right off the bat, the lady tells me that they WILL NOT accept anything International. When I asked her why not, she had no answer. I asked here if that was a UHC rule or the IRS. She said that UHC goes strictly by the IRS guidelines. So, I asked her to find for me where it said that FSA could NOT be used for international medica…

My insurance has a weight-loss surgery exclusion, so I would be a self-pay patient. I attended the seminar & got approval for decent financing from my Credit Union. I am looking at Self Regional in Greenwood which charges $11,800 (Is this a good price compared to Mexico?) I have a consultation appointment this Friday. However, I keep wondering if t's worth it to pay that much out of pocket? I have this fear I'll have this debt for say, 3 years, and by the time my debt is paid I'll have gained back the weight. Are the long term results worth it or will I be paying to get osteoporosis later in life due to malnutrition? I'm sure other self-payers have had similar f…

I was approved back in November after 4 months of monthly visits and now I'm in week 7 of 10 week online program for total of about 6 months. I called today and asked and bariatric center said they would have to call and verify it and call me back but I have a 70/30 plan. Now I'm freaking out that I may have to come up with several thousand for my portion. I just don't know if I can swing that.... I will be severely disappointed if that is the case. I may be able to he a loan or financing but I'm really hoping its no going to be as much as I'm fearing ... Any ideas on this or your experiences ??? Thanks !

So I was banded May 2011. I have Cigna insurance and they didn't cover the assistant that helped the surgeon during my surgery. They also had to repair a paraesophageal hernia during my surgery, which they never mentioned to me anytime after. I only knew I had the hernia because I got charged for that as well on my hospital bill. Do I have to pay for these? Is there anyway I can fight these charges?

Hello all, Just had the Initial meeting with the Surgeon today, and went thru all the insurance stuff with the insurance coordinator..... .....as expected, I could not get a specific number or even a general number of what my finale out-of -pocket cost for this surgery would be. ($35k to $100K) My primary insurance covers 80% of the cost associated with the surgery, I would assume my secondary would cover the remainder of the cost leaving me with a nominal amount to have to pony up before anything is done. I have Banner Health insurance as my secondary, there is a min. $5K deductable for elected surgeries. She lead me to believe that I would have to pay that to…

Hi all, just wanted to see if anyone out there has been approved lately for Lap Band that has Aetna POS II insurance??

Hello everyone! I hate that this is my first post, but well, I just don't know what to do! I been reading and reading all of these wonderful posts .. getting encouraged and now... Bam! I promise not to make this long. I went to my first seminar at Emory Johns Creek hospital here in Georgia just the other day. I was so encouraged! It's an American Board of Bariatrics hospital of excellence. The Chief of Staff/director of bariatrics was there and talked about the surgery... etc.. It was GREAT! I immediately came home, and started looking at my BCBS policy and don't you know it says that surgery of any kind for weight loss was not covered! I was not to be deterred! …

I am so frustrated right now. I have submitted twice to Wellmark for approval of the sleeve, both times denied. This last time the only denial was no proof showing chronic corticosteoid use. Now, I have sent in all my notes from my ENT Doc showing my Flonase use and oral steroid use and a letter from my ENT doc saying yes I am on a corticosteriod and have been for the last two years since nasal surgery and will continue to take it with my chronic allergies. What more do they need?????????????? I called my insurance and they are setting up a peer to peer review so the doctors can hash this out. I am so upset. I have worked so hard to get this completed and approved a…

So I called my insurance and asked if WLS was covered. The rep told me yes, but she couldn't tell me which one exactly. She said the doctor would "put it in" and then I will know whats covered. I'm like "huh?" Should I call again and ask. I think the person I spoke to didn't really want to get into specifics. I have a feeling only the band and bypass would be covered. Or should I wait until my consultation?

I have been through my six months of dieting, labs and everything...I had my bariatric doctor submit everything to BCBS of Florida State Plan. I am worried that I am going to get approved. There is no reason for me to get denied but I have the jitters. My worry is that they wont approve the sleeve procedure. I know that the approve for gastric bypass but that is not something I want to do. Is there anyone else that has had vertical sleeve surgery where BCBC of Florida paid for it??????

It has been a long stressful haul since I started all of this last July. I had to file an appeal with my insurance company to get an initial consultation with my surgeon because my Health Management office said that my BMI was too low to warrant the evaluation. Now I have to get all of my testing done and lose 5% of my weight before they will schedule the surgery. I wonder how long all of this will take. I'm glad that I didn't give up when I was thinking about it. Many thanks to all of you who encouraged me to keep at it even when I wanted to give up

I posted a list of resources with tips for getting WLS approved easier with your insurance company. Hope it helps! :-) http://www.formerlyfluffy.com/weight-loss-surgery-insurance-approval-resource/