Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Do you have insurance that approved the sleeve?



Recommended Posts

i have anthem blue cross of ca and they denied me d/t experimental so i contacted the Dept of Managed health care and requested an independent medical review and because of arthritis i need to take anti inflammatory meds so i won my case and anthem had to pay for it,,, done,, couldn't be happier,,,also united,,aetna,,kaiser and now cigna?? starts with a c sorry having a senior moment all cover the sleeve now best of luck to you

Share this post


Link to post
Share on other sites

There is an HMO here in California called Western Health Advantage that covers the sleeve and my current HMO Kaiser Permanente that is covering my sleeve surgery 100%.

Share this post


Link to post
Share on other sites

Cahnge for the better. You and I are about the same size! I have Cigna insurance and after the 6 months supervised diet and a trip to the nutritionist and the Psychiatrist, my insurace approved me for sleeve surgery. I wish you the best of luck. With most insurances it is either the higher BMI or high BMI with co-morbidity issues.

Share this post


Link to post
Share on other sites

Hi - I have UHC and they approved the gastric sleeve. They didn't make me jump through hoops but they did require the following:

5 year history of obesity

6 month supervised diet (3 of which had to be consecutive)

At least 100 pds over goal weight or I think a 30 BMI and a co-morbidity.

Need Psychological Eval

I started the journey in May 2010 - and had all paperwork ready before Memorial Day weekend and was approved within 2 weeks.

However, my general physician was really good about putting the papers together. I have seen her for 15 years so she was wonderful about it.

I am scheduled to go in on June 29th -- every day I question my decision. I am on the Optifast diet and have been on it for 10 days and have lost 7 pounds. The first week I only lost 3 and I was stressed out because I thought to myself -- I am NOT eating and I only lose 3 pounds in one week what about when I do start eating? How am I going to lose anything? Does that make sense?

I am scared because I have two small children who need their mother HEALTHY!! But, like everyone, I am scared of not coming back to them. But I am trying to be optimistic and deal with the decision that I have made. :thumbup:

Share this post


Link to post
Share on other sites

I think with any surgery we question our decision!!! But I think we also over stress outselves and sometimes overthing things. I am sure you will be just fine and come through with flying colors and be a healthier Mother with a lot more energy to enjoy your children.

Keep us posted!!

Share this post


Link to post
Share on other sites

Hi - I have UHC and they approved the gastric sleeve. They didn't make me jump through hoops but they did require the following:

5 year history of obesity

6 month supervised diet (3 of which had to be consecutive)

At least 100 pds over goal weight or I think a 30 BMI and a co-morbidity.

Need Psychological Eval

I started the journey in May 2010 - and had all paperwork ready before Memorial Day weekend and was approved within 2 weeks.

However, my general physician was really good about putting the papers together. I have seen her for 15 years so she was wonderful about it.

I am scheduled to go in on June 29th -- every day I question my decision. I am on the Optifast diet and have been on it for 10 days and have lost 7 pounds. The first week I only lost 3 and I was stressed out because I thought to myself -- I am NOT eating and I only lose 3 pounds in one week what about when I do start eating? How am I going to lose anything? Does that make sense?

I am scared because I have two small children who need their mother HEALTHY!! But, like everyone, I am scared of not coming back to them. But I am trying to be optimistic and deal with the decision that I have made. :thumbup:

I have UHC but my plan doesn't cover any obesity services. I appealed and am waiting to hear back. I know what you mean about 2 small kids. I have a 2 yr old and 5 yr old. I feel selfish for getting the surgery because there is a chance I could leave them motherless but I know I will continue to be over weight my entire life if I don't. No great words of wisdom, just that I'm in the same boat with you :)

Share this post


Link to post
Share on other sites

I have UHC and I was required to do the 6 month weight loss program with my surgeon. The time really flies honestly. It is worth it. I have my last weigh in on July 1st. Hoping for a quick approval and surgery date soon.

Share this post


Link to post
Share on other sites

I feel selfish for getting the surgery

I felt selfish, vain, etc. Then I questioned what I was doing getting an elective surgery. I wasn't 'that' obese... I was finished with the surgery and 4 days later I was texting my hubby on how stupid I was.

Now, 13 days post surgery, 14 # lost, I am very glad. I deserve a healthy life with my family and my family deserves a healthy mom. How many times do you put your needs on the back burner to take care of the kids/hubby. This will be about you! (and your hubby and kids will benefit for the new you).

Good luck.

Terrie

Share this post


Link to post
Share on other sites

This surgery is one step on the journey to a healthier you. If you are commited to using the tool along with diet and exercise you can accomplish anything. I am amazed at the stories on this forum of people who have reached their goal (and are keeping it off)... and the people who are doing it right now!! I am so glad I found this forum. Before reading some of the responses in here I felt like I was sooo alone. It is nice to have people who really "GET" what you are experiencing.. pre-op and post.

Share this post


Link to post
Share on other sites

I've had UHC since it first became UHC in Arizona. I tried on my own to get approved in years past for bypass, and was always turned down. I'm thankful for that. In January I went to my information seminar and learned of the sleeve. I had never heard of it before. The Doctors office did all the work this time. I spent the next 6 weeks doing all my appointments....sleep study, psych, blood work, nutritional counseling, pcp letter, etc. The liason for the Dr's. office sent the paper work in on Friday morning. On Monday morning she called to say I was approved.

I've been super morbidly obese (over 300 lbs) for the last 23 years. I had (notice I say now...HAD) high blood pressure and on 3 meds for it. Osteo arthritis and on Celebrex, gout, and prediabetic. Maybe this was why they gave me approval so quickly.

Share this post


Link to post
Share on other sites

I ahve UHC Choice plus and they paid for mine 2 months ago. When you get ur card go to the my uhc website and look under ur benefits.There was a phone number for Bariatric resource services 1-800-936-7246 and they told me of my employers covered it. I was dead in the Water until I called them as I had already gone to a seminar and couldnt get anything from insurance so after 3 weeks I called them and it was easy from then on. I had to have a 6 month diet history and a psych eval. If I can help in any way pm me.Carla:biggrin0:

Share this post


Link to post
Share on other sites

I have Blue Cross/Blue Shield through my husbands work. I had no problem getting approved. They told me my BMI had to be 45 or over and mine was 52. They cover 100% of the hospital stay and 90% of the Doctor.

weight.png

Share this post


Link to post
Share on other sites

WOW! So glad to hear all the positive news about how insurance is covering the sleeve now. I'm pretty positive that my UHC Choice Plus will cover it, I just don't know what pre op requirements I will have to meet. I guess all I can do is wait to get my insurance card and then start the process as soon as it comes in. I have been seeing the same doctor since I was 14 so I'm sure there is plenty of documentation of the 2 times I was on Phentermine, the several years of my yo yo weight. The constant talk about what I can do about my weight....

If I have to do a 6 mo pre op diet that wouldn't be a problem either. I just want to try and have the surgery before the end of January. I have it all planned out. I can recover for 1 1/2 years and then get pregnant and have my first child before I'm 28!

You see, I have it all planned out! :) I just hope everything finally falls into place!!!

Thanks for all the information!

Kara

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Eve411

      April Surgery
      Am I the only struggling to get weight down. I started with weight of 297 and now im 280 but seem to not lose more weight. My nutrtionist told me not to worry about the pounds because I might still be losing inches. However, I do not really see much of a difference is this happen to any of you, if so any tips?
      Thanks
      · 0 replies
      1. This update has no replies.
    • Clueless_girl

      Well recovering from gallbladder removal was a lot like recovering from the modified duodenal switch surgery, twice in 4 months yay 🥳😭. I'm having to battle cravings for everything i shouldn't have, on top of trying to figure out what happens after i eat something. Sigh, let me fast forward a couple of months when everyday isn't a constant battle and i can function like a normal person again! 😞
      · 0 replies
      1. This update has no replies.
    • KeeWee

      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
      · 0 replies
      1. This update has no replies.
    • Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×