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I'm new here and just starting to do my research. Lap band sounds like it would be great for me. I'm in Florida and have CHP (Capital Health Plan) insurance. Has anybody had any luck with them?

Edited by Destined

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Has anyone heard of an insurance company giving a verbal approval code and then a denial after surgery was preformed?

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Hi, I'm from VA, and have been going through the approval process with my Insurance Co. BCBS of Georgia since February. What a nightmare. Gary, If you're still out there, I would love some help if you could give it to me. First denial came because they said I wasn't a covered member. Obviously an admin mistake that took about 5-6 weeks. Second denial said I needed a nutritional eval, which I got and Weight Loss Center resubmitted. Next denial came today (several weeks later), saying I needed all sorts of things, that have already been done and provided to them. Ex. Psych eval, letter of necessity, etc.... These have all been given. They are definitely giving me the runaround. All my insurance required from the beginning, was a letter of necessity from the surgeon. So they say... It's been a crazy frustrating ride. Pls. help anyone if you can.....Is there anything anyone can recommend to help me fight them?

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Grandview Hospital in Dayton Ohio is a Center of Excellence. I just attended the seminar Thusrday and they mentioned this.

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I work at a hospital and have Gilsbar. I am told that Bariatric surgery is "excluded". Is there anyway around it. I meet all other criteria. My insurance will pay for all the results caused by being overweight but not help me fix the root problem. Do I have any chance of coverage? It's funny, but I have learned that a lot of school teachers are covered because their employers want to keep them healthy and working a long time. Why is that focus not also in the hospital setting, where I work?

Please let me know if I should pursue coverage or just pay out of pocket. I need the surgery for my health.:confused2:

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I f your insurance has an exclusion...I don't think there is anyway you can get them to pay for it. Your bariatric doctors office may have a suggestion, but paying out of pocket is probably going to be your only choice.

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Hi guys...i dont know if im in the right place to ask this question but...I have UHC ppo. They cover 90% for bariatric surgery. Ive done all my testing. sleep study, ekg, blood, urin, chest xray and endoscopy. Then "today" my surgeons office tells me that i have to have a five year history of having a bmi over 40 or two co morbidities. First of all...why didnt they tell me this at the beginning? and second is this stated in my policy? they flat out told me all of a sudden that it wont be approved by my insurance? This is such a slap in the face. Ive been over weight all my life, my bmi is 40 and i weigh 230 lbs. 5'3". Yes my weight has dropped 5-10 lbs up and down forever but COME ON. thats rediculous! Does anyone have any recommendations or ideas, answers, hope??:rolleyes2:

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My experience is that UHC rarely (if at all) requires a weight history. You should never give an insurance company information they don't require as it is just giving them ammunition to deny you.

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So dont send them my 5 year history? The surgeons office required me to fax them my five year history. Then they said i wouldnt qualify because my bmi hasnt been over 40 for five years straight?? SO thien i called my insurance myself and actually ive called and asked 6 times. not one person found anything in my policy that stated that i had to have a 5 year history of a bmi over 40!!!! what the heck? Im so confused at why the office would tell me that before they even submit to my insurance.?

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Hi, can you tell me , did medicare pay for all fills also? Thanks so much.

I am hoping to be approved soon.

Karen

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Obesity Law and Advocacy Center - has anyone heard of them?

I am appealing through them (information given to me by my doctor's office) No cost to me or practice. Any information would be appreciated if anyone knows about them. Thanks.

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Can you please help me, I need to know if you know the name of an attonery that helps fight the insurance when they say no, and its medicaly nessecery thanks lisa

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My insurance company denied me saying not medically necessary. I am going ahead and having surgery on a cash basis. Does anyone know if I can appeal the insurance decesion and possibly get reimbursed my cash payment.

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
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