If you need help understanding your benefits, I can give you advice from the hospital/facility side of things. Part of my job is to get prior authorizations and calculate how much patients will owe for certain services. I haven't been getting notifications when someone posts on here so if you don't get an answer within 24 hours then send me an email at sseelbach@live.com.

Edited March 13, 201610 yr by Sarah 82

Thank you SO MUCH for your help! I have united healthcare Mdipa, in Virginia. I'm a federal employee. Do I have to have 6 months consecutive or will 2, 3 month programs qualify me for a sleeve?

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Sarah 82, I have Excellus SimplyBlue Plus Silver 10 and I cannot get an answer as to whether or not I need to have a 6 month supervised diet and weight loss plan. Is this something that you are able to check into? I've called the insurance company twice and they've emailed me paperwork but it is like reading a foreign language. At my first visit to the bariatric center, I brought all the paper work that insurance had emailed me and the nurse looked at it and said I was fine since my BMI was over 40. Then the same nurse asked me last week if my insurance required a 6 month supervision period.

If you need help understanding your benefits, I can give you advice from the hospital/facility side of things. Part of my job is to get prior authorizations and calculate how much patients will owe for certain services.

Sarah, If my employer excluded all Bariatric procedures in our coverage, what options do I have?

If you need help understanding your benefits, I can give you advice from the hospital/facility side of things. Part of my job is to get prior authorizations and calculate how much patients will owe for certain services.

Sarah, If my employer excluded all Bariatric procedures in our coverage, what options do I have?

You'll be considered a self pay patient. The only option you have is to find out how much the facility where the surgery will be will cost. They're who you'll have to pay upfront. Most facilities will give self pay patients a 50% discount off the total cost of the surgery. Then you'll probably be expected to pay half of that upfront. Where I had mine done, it would've been about $15k if I wouldn't have had insurance. That doesn't include any inpatient stay.

Sarah 82, I have Excellus SimplyBlue Plus Silver 10 and I cannot get an answer as to whether or not I need to have a 6 month supervised diet and weight loss plan. Is this something that you are able to check into? I've called the insurance company twice and they've emailed me paperwork but it is like reading a foreign language. At my first visit to the bariatric center, I brought all the paper work that insurance had emailed me and the nurse looked at it and said I was fine since my BMI was over 40. Then the same nurse asked me last week if my insurance required a 6 month supervision period.

@@Sarah 82...I have Cigna insurance and they confirm they received my paperwork on March 2nd but I'm still pending. Almost all the post I've read about Cigna say they were approved in about 2 days. Is the fact that I'm going on week 2 and still pending a bad sign? When I called, they said it was being reviewed by a nurse and would then be reviewed by the medical director.

Sorry I didn't get a notification with your post. If you still need help, send your name, dob, and insurance id to my email. I'll check your benefits from work this week. Sseelbach@live.com

@@Sarah 82...I have Cigna insurance and they confirm they received my paperwork on March 2nd but I'm still pending. Almost all the post I've read about Cigna say they were approved in about 2 days. Is the fact that I'm going on week 2 and still pending a bad sign? When I called, they said it was being reviewed by a nurse and would then be reviewed by the medical director.

It sounds like it's just in medical review right now. That's not necessarily a bad thing. Also, policies vary so just because someone else with Cigna got theirs approved that soon doesn't mean yours would've been. Some insurances even have what's called a predetermine period and those can take up to 30 business days. If you'll send me an email with your full name, DOB, ID#, and the exact name of the insurance on your card I can look into it further this week at work. There may be something they're waiting on in order to process a decision. Sseelbach@live.com

@@Sarah 82...I have Cigna insurance and they confirm they received my paperwork on March 2nd but I'm still pending. Almost all the post I've read about Cigna say they were approved in about 2 days. Is the fact that I'm going on week 2 and still pending a bad sign? When I called, they said it was being reviewed by a nurse and would then be reviewed by the medical director.

I also have cigna. The first time I submitted they came back with with a denial in less than two weeks. They added some more tests and I finished those and re submitted on March 1st. Still no word so I totally understand what your saying. All these others getting approval so fast and for us it's taking forever

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Called today and expected for the automatic system to say pending but it said approved!!! Over the moon right now. Just waiting to hear from my surgeon's office for the next steps.

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I'm new to this site and I have just browsing the comments to see if I can get answers to my questions. I currently only have Medicaid and I wanted to know is there any individual insurance that I can get personally that will cover this procedure?

If your Medicaid will pay for it, that's going to be your best option because you won't have any cost share. Also, idk what state you're in but for Texas, it's very rare that you would qualify for Medicaid if you've got commercial insurance. That said, yes, there are several insurances that have bariatric coverage.

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Is there anything you can tell me about 1199 national benefit fund ?? Is it this going to be a challenge for me or are they pretty easygoing.? I have Aetna as a secondary if that makes a difference

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