Insurance & Financing

My daughter is getting ready to begin the approval process with Tricare Reserve Select. Will be 18 in June. What kind of out-of-pocket expenses should we expect? Thanks so much....

So this might be kinda silly, but here goes. For insurance approval - I have Empire BCBS - we need to prove prior attempts at weight loss. I was never able to do anything like Weight Watchers and the like because my parents never really had any money to spare, you know? So I did over the counter things: Slim Fast, tried a few of those silly diet pills. I've kept a record over the past two years or so of my weight, marked it on the calendar at the end of every month. But I don't have any doctor - and I've seen plenty - ever telling me that there was something specific needed to be done, just that I was too heavy and to do something about it. My PCP already wrote a let…

Does this really work and how does it work

Does anyone know if Spartanburg Regional (Spartanburg, South Carolina) has a self-pay program, and the approximate cost? Their website is very vague. Thank you!

My surgery was originally planned dec. 12th but cigna waited until the last min to tell me the hospital was not a "center of excellence". So I switched hospitals and now im approved!!!! I have been on here reading all approved forums and now I get to be a part of it

If anyone has had Tricare (North Region) can you please help me. I am totally confused. I understand that I would not need to have a medical supervised weight loss before surgery if I can document that I have done so in the past. My insurance person at my health facility is telling me that it is a requirement for Tricare. I am stressed as I am just starting this process and I really need your advice. Thanks. NO FoxyMomMa Yet

I really want the sleeve. I was originally researching the RNY, but with all the research and information decided to go with the sleeve for a lot of reasons. Now to my question, I have heard that Carefirst only does the sleeve for a 50 or over BMI? I am coming to the end of all of my insurance hurdles and I am really getting nervous that I will be denied because of a low bmi (for sleeve). Does anybody have any experience with Carefirst?

Hello everyone!(: I'm new to this website, but i've read loads of peoples stories and i find all of them helpful and/or inspiring!!(: I've been doing research on lapband for a while, and it's something i really want to get, i just attended a seminar this past tuesday. (first steps! yaaay! ) I have tricare prime and i wanted to know what you all think my chances of getting approved are?! I'm 18, I have a BMI of 42, i've been overweight since i was five, i have gallstones and i have to get my GB removed, i have other minor problems due to my weight also, I've tried multiple diets, and my doctor even sent me to a dietician for a while. Please let me know what you think m…

Does anyone out there have providence? Wondering what kind of a fight I'm in for...

Has anyone gone through approval with BCBS of RI? I am trying to figure out how long it will take them to approve me for surgery. I just finished my 3 month supervised diet in which I lost a little and gained back the same amount (the story of my life that one), I am finishing up my 4th month right now while waiting on my consult with the surgeon. I am hoping to be banded sometime in mid to late September but it's all based off of how long it takes for the approval process. Any info on personal experience would really help!

I am in month two of the three month process with Aenta insurance. It states in the clinical bulletin that you should be losing weight during this period to prove that you are willing to make the lifestyle changes necessary after surgery. My doctor's office does not require me to lose weight during this time but stated not to gain any either. My BMI is at 39.9 with sleep apnea as a co-morbidity. I have lost five pounds and I am sure I can lose a few more within the next month but feel like its a catch-22. I don't want to lose too much afraid they will say if I did that well, I can do it without surgery. But at the same time, want to lose enough that they see I am committe…

I started my journey in Sept. went to my first visit to surgeon after seminor. The very first visit they called my insurance co and they said it was covered except for 1000.00. So i started making appt with other doctors so i could have my surgery. Did my nutrition classes and all appts the doctors office sch my lapband and 4 days before my surgery they called me and said that the lapband is excluded from my policy. i have talked to the ins co nothing i can do. I have spent alot of money on the other appts that are required for the lapband missed alot of time from work unpaid. I have wrote a letter to the doctors office with no response. I have talked to one of the girls…

I have worked in the medical field for 24 yrs and I don't even know what exactly this means as far as what my out of pocket will end up being. I have a primary and secondary both 2 different forms of bcbs Tx We are still working on whats what but maybe someone who has dealt with the coinsurance aspect will fill me in thanks!

My BMI is 56.3. I am wondering would I be approve since my BMI is so high. What you all think?

I have not yet gone through the approval process, but I am anxious I know my in-patient hospital copay is $250, and my Dr. office has a $300 admin/class fee... But is there also a seperate surgeon copay? Or just my regular $25 office copay for the actual surgery, or is that all included in the hospital copay?

Wondering if so, what steps did you have to take, and how long did it take for you to get approve?Need feedback

I am not about to give up on this, but this is getting really difficult and discouraging. I need to find a GOOD surgeon for a consult and hopefully weight loss surgery and I am getting NOWHERE. First I tried calling my insurance provider to see what doctors were covered under my plan, but they said they cannot "look-up" a weight-loss surgeon, only a general surgeon. So I start looking up weight loss surgeons online and from this website, but none seem to be covered. I feel like this is just one big vicious cycle and I cannot seem to get this process started, which I am SO DESPERATE to do! Any suggestions?

I am having a tough time finding financing for the gastric sleeve. I have been researching this for the past year and really think I am a good candidate. I currently have no health insurance because I am a temporary employee. I also do NOT have good credit so financing is not an option. Also saving money is hard these days. I also thought about buying health insurance but they don't want to cover me with a pre -exisiting condition, What can I do?? I feel hopeless and my health is suffering. I checked out Mexico but like I said financing is not an option unless I can find a bad credit loan company. Can anyone relate or point into the right direction??

Hello Everyone, I have been a long time lurker. I love this site. You all have helped me tremendously. What has your experience been with the decision process with Cigna (Open Access Plus)? How long does it take to get approval from the time of documentation submission? Any information will be greatly appreciated. Thanks.

Hello All! Happy New Year! With the New Year, I am sure that everyone is looking forward to a new beginning and future as am I! The issue that I am having is trying to get a straight answer from my Insurance Company (ies) regarding who is the primary payer on any medical procedure, device, or medication that I have prescribed to me by a doctor. I’ve finally made a decision to have the vertical sleeve done by Banner Gateway MC in Gilbert, AZ. I think that will be the best option for me in the long term. What has me even more excited is the Idea that it is a covered benefit thru the Insurance provided thru my company, United Healthcare, and thru my wife’s Insurance,…

Has anyone had an issue with GHI insurance??

I have been lurking on the site for about a year cheering on everyone's successes and being inspired by people's triumph over the more challenging aspects of their journeys. I was in a dead sleep this morning sleeping off the effects of 3 back to back 12 hour shifts, when I got the call from my insurance coordinator @ 10:45am. When I saw the phone number, I was scared to answer because I was afraid of being denied but i put on my big girl panties and answered the phone. She said I am happy to tell you that you were approved by your insurance company. After I got off the phone I literally jumped out of bed and did the stanky leg and started dancing and crying at the s…

i was just looking into my benefits book for Federal Blue Cross Blue Shield BASIC option. it seems that i will have a $150 per night fee for the hospital (one night) and a $150 per doctor (I think there will be 2 surgeons). just wondering if anyone else has this insurance. thinking about what other costs i will incur for the surgery. i already paid all my co-pays for all the specialists to get approved for the surgery. wondering if there will be an anethesia (spelling) cost or co-pay. just want to prepare my husband before all the bills come rolling in. thank you.

I was reading a few posts and noticed that BC/BS seems to be a toughie insurance company. I have BCBS-Texas and was curious how the experiences went with them. Thx yall!

I know i have a while before i get my approval and surgery date but I am the type of person who likes to have an idea of how much i may need to pay WAY ahead of time. I have cigna and its 90/10. So i know i will pay 10% until i reach my out of pocket maximum of 2000 (after my 300 deductible of course) so is it safe to say that all i really need to know is that im guaranteed to pay at most 2000? since thats what my insurance benefits are? thanks for you help

I'm looking into lap band but my insurance doesn't cover it. I was approved for financing through care credit, but wanted some feedback first. Anyone have any feedback on care credit? I live in TX

Hi there - Recently it was confirmed that my insurance does not cover WLS under any circumstances. I had thought that I would go the Gastric Bypass route as that was what I had assumed my insurance would pay. Since they are not covering anything, and I am now a self pay, I back to weighing the differences in terms of Gastric Bypass and the Sleeve. For many reasons the sleeve is much more attractive and is what I am leaning strongly towards. I have an appt with my dr. office to speak options now that I am driving the decision and not insurance in term of surgery options (I have gone through all of the Center of Excellence criteria - meetings, phsy evaluation, 3 month…

I am in the beginning stages of trying to get approved for the Lap Band Procedure. I work at a Police Department and our insurance is not the greatest. I know they pay half...Which I am ok with. Just wondering if anyone had any experience with this insurance and trying to get inproved.

Hi Everyone, I had my psych eval yesterday. The Dr. and I talked for about 30-40 minutes about my social, family and medical history. He said that I was fine and that I would do very well with the surgery. So far I am 1/2 through my 4th month of the 6 month doc/dietitian supervised diet and exercise program that Cigna requires. I already have my appointment scheduled for my 5th month visit in January. So that puts February as my 6th month. I do my appointments the 1st week of the month. Does anyone know how soon after my last appointment the surgery request documents can be sent in for approval? Do I have to wait till the end of the month or can they be sent in…

So at 4 months into my 6 month required weight loss program by BcBsIl I find out my insurance has been terminated for the last 3 months!!! My ex husband is supposed to carry coverage for as long as we are both single. He's been off work due to injury so the insurance lapsed. Now that he's back at work the benefits office said the insurance will be back dated to the day he came back to work which was about a month ago. My insurance coordinator at the surgeons office said to continue on program and come Feb it shouldn't be a problem because I still would have met my qualifications. So I'm hoping and praying that this won't be a setback and that it doesn't cause a problem …

Hi I'm new here and was just curious if anyone here has SuperMed As their insurance provider? If so what's been your experience with them?

I looked into my insurance requirements for the sleeve. I have been seeing my pcp for the 6 month supervised diet. I made the appointment to see the nut doctor. And I been goin to the gym. I feel like I'm missing something. This is what they want. Patient selection criteria for bariatric surgery include (NHLBI, 1998): Documentation of a motivated attempt of weight loss through a structured diet program, prior to bariatric surgery, which includes physician or other health care provider notes and/or diet or weight loss logs from a stru…

Hello all, I'm a noob. I want this surgery, rather I need it. I'm not sure how things are done elsewhere but around here, the surgeon or practice has you go to an open information session first. I am going to one next Tuesday. After I get the ball rolling on getting my first appointment with the doctor and such I'm just wondering on how much waiting time I am looking at. I know that all insurances work differently so I'm wondering if anyone has had experience with Empire BCBS PPO of NY? Do they make you do the 6 month diet with the doctor first? One of my colleagues had another bariatric procedure and her approval was fast, around 30 days. But I'm wondering i…

Hey everyone!!! I am so confused! I keep reading all of these forums on lapband and the insurance process and now I am starting to get concerned. I have Highmark BCBS out of Pennsylvania. I started my whole banding process on June 5th with my PCP supervised monthly visits. I did my seminar in late May in which I found out that indeed I was a candidate. So like I said, June 5th was my first PCP weigh-in. I had my monthly visits all the way up to Dec 5th. In September I met with my surgeon in which she game me a list of tests to have complete. I complete my bloodwork, sleep tests, Upper GI with Barium, and now I go Thursday for my Pysch and Nutritionist visit. (Thi…

I was recently added to Anthem BCBS insurance plan with Kroger because my other insurance plan did not provide any coverage. Has anyone else tried to use their insurance immediately (within 2 months of add) for this procedure? I'm worried they may deny me because I was literally just added, but I am above 40 BMI with high cholesterol, high blood pressure, and some other issues. I was able to get a letter written by my pediatric doctor (who was my doctor from birth to 20) suggesting I should be a candidate for Lapband and documenting I have been obese since age 7, as well as my growth charts and chart notes in regards to weight/BP. I do not have a new primary care doctor,…

So cigna denied me because the hospital was not a center of excellence and gave me the appeals process. But I went to a center of excellence and the insurance verifier just said they would send a new request with their hospital. I dont know if they are sending an appeals letter so im hoping this will qualify.

I have been on depo shots for a year when I first started I asked about weight gain. My doc put me on a diet not really to get weight off just so that I didn't gain weight. So I have uhc and I have to do a 6 month supervised diet. I called them today and asked about the 6 month diet and they said It didn't have to be a monthly weight ( I called twice). But I didn't think about the gyno till now. So I typed all this to ask do u think I can use the year for the 6 month supervised diet?

I am writing today with such joy for the season and hope for my future. My journey began in February of this year. It has been an up hill climb and emotional roller coaster since day one. The first snafu was my primary care office who had not followed through and forwarded my records to the bariactric center as I had requested. After three requests that was resolved in March, as most of you have experienced I had all the hurdles of the insurance company and bariactric center requirements to meet, dietician visits, nutritionist visits, egd, physical therapy and psychiatric evaluation along with some weight loss and exercise requirements. Many trips to the bariactric site w…

Hey everybody! I havent been around for while because of how sad I have been. But today my big sister told be to get off my butt and take care of business. I have been doing my supervised diet with my pcp since May. As of November 6th my 6 months is up and all of my qualifications have been met. Last minute my pcp said I need to go to more classes for 6 months to another medical group that is 45 minutes ( one way) away. Classes are once a week for the first 3 months then twice a month for the last 3. At first I was shocked and mad. I have posted about this issue before. But now I have more details. After being upset, I came around. But I still couldn't get to the…

Hello VSG Talk. I have been here for nearly a year now, first lurking, then excited as my journey unfolded and hanging out quite a bit. Then after my first insurance denial I slowed down on my visits. I appealed and was denied a second time and haven't stopped by at all. My surgeon has appealed yet again and this coming Tuesday the 13th I am scheduled for a second and final appeal. I have been invited or a representative to join the meeting (impossible due to distance) or via phone conference. My surgeon has no offered to join in and has wished me luck. I assume that means I'm on my own. Has anyone here joined in on one of these appeals? What is it like? Should I be…

For the surgery I was with United Health. Under my new employer I'm with Aetna. Aetna refused to pay for my latest fill. Is this unusual or was it not coded properly by the doctor's office or something? thanks

Has anyone been denied because they gained weight during the 6 month supervised diet??? I legitimately gained 5-7 pounds b/c of medicine I was on, but I was still 8-9# shy of meeting the 40 bmi requirement, so I cheated a bit. Well, I cheated more than I thought and the doc's scale said i gained 15# in 1 month...AHHH! I am afraid it will be obvious as to what I did and they will deny because of this. Anyone know??

FINALLY APPROVED BY BCBSI!!!!!!!!!!!!!!!!!! iT PROBABLY TOOK LIKE 7 DAYS TOTAL TO GET APPROVED.

Hey Everyone, I've been reading old posts and saw somebody say that Medicare doesn't pay for fills...but that was in like 09 I think...Does anybody know if that has changed? And if not, do you know how much it usually costs for a fill appointment? Up until I joined this forum, embarrassing as it is I actually had no idea there were fills! I just thought my insurance would pay for the follow up appointments and I'd be all set...Also, I live in Connecticut and I'm having the surgery at the Backus Weight Loss Center. Thanks in advance. -Stephanie

I mentioned this yesterday in a post, but the more I think about it the more its driving me crazy. Does anyone who has BCBSIL every dealt with the surgeons office saying they cant do the surgery because they are not a blue distinction site? I was told that yesterday, but also I called BCBS to confirm myself and they say that is not true. Specifically, my policy says nothing about this requirement per the BCBSIL rep. In researching the blue distinction centers on BCBSIL website, I found the statement below with indicates its voluntary for the member. I just don't know how to get the surgeons office and BCBSIL on the same page. One thing is confirmed- the surgeon is in th…

I got verbal approved from BCBSIL today and they also faxed the letter over to the surgeons office while we were on the phone. It was after 5, so I am going to call tomorrow and start asking about dates. Hopefully they will accept the faxed copy for now while the hard copy is being mailed. I know I have a 4 hour nutritional class to take but other than that I hope I'm done. Really excited... so glad I have a place where everyone understands my excitement.

A quick background - I had a lapband slip diagnosed in June. EGD confirmation in July. Band removed in September. And last week my insurance denied my revision to a sleeve. I have a background in the insurance industry so I'm not completely at a loss, but... My surgeon had a wonderful lady who knew the revision process inside and out, who quit just a few weeks ago. Their new lady is, well... new... and I'm her first revision case. Uh oh. So I'm kind of having to be my own advocate, because she just doesn't know. The reasons for my denial were: Failure to submit proof of a mechanical failure Failure to document proof of adherence to the prescribed diet and exer…

Yesterday afternoon, I was just bothered by the whole will they/won't they mind game of insurance approval. Now, I realize I can't even submit for another month. I have one more weigh in for my MSWL program requirement. I called BCBS-TX yesterday and asked her if I had to use one of their Blue Center of Distinction for Bariatric Svc. She put me on hold and came back and said for Bariatric Surgery, no I don't. She told me that it is all up to the policy riders that each employer puts in the coverage. She said our insurance has that requirement for Organ Transplant, but not for Bariatric Surgery. So then I asked her to repeat the requirements so I could make sure I…

Title says it all - im getting insured with Aetna on 12/27 and I need to finish my enrollment in the next week or two. Im still getting packets and paperwork and im a little lost. For those of you who do have Aetna, would you share some plan details? I dont need your insurance ID, numbers etc - just some basic information such as whether you have PPO or H MO and what selections you have. I know it varies from employer to employer, but having this kind of information on hand would be amazing. Edit: *** censored? =(

I am applying for additional life insurance coverage thru my employer and have to fill out a medical history. I had my VSG in 2010, in Mexico. My PCP here in the states knows about it, and it would be noted in my medical records here. And I am thinking, as I write this, that I have no choice but to include it in my medical history for the life insurance. I just feel that putting Mexico on the application that I will get denied for the coverage (the form requires Dr/city/state). I don't know....maybe just being fearful of prejudice..... Has anyone else experienced this? What would you do? Thanks!