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They were great! They approved me in less than 24 hours after they received the letter of medical necessity. I called them every day (twice a day a couple of times), until they told me they had the paperwork. They told me to call them as often as I wanted. Once the letter went to the pre-certification department, it was approved in less than a day. I hear the things that Aetna check are co-morbidities, current BMI and previous attempts to lose weight under a physician's care. Just make sure you have all of your ducks in a row when sending in the letter of medical necessity (everything documented), and you should be fine. (Keith M.) Aetna - PPO (KS) - 04/27/03 I actually changed insurance from Coventry Health (HMO) to Aetna PPO in January 2003. Coventry would not pay for this surgery, they deem it "cosmetic surgery". It is amazing to me how many insurance companies are so ignorant still of the plight of the morbidly obese. Or maybe they just don't care. Probably they just don't care. Well, I switched to Aetna PPO as soon as possible, which was the beginning of the year, because they do pay for this surgery. I had a co worker that had the surgery in 2000 and she had Aetna PPO. So, I knew I would be okay with this insurance. I couldn't believe they turned me down on my first application. They had a new clause in the plan. Not only did you have to be 100 pounds overweight and have a doctor deem this medically neccesary; but you have to within the previous 2 years have 6 months of doctor supervised weight loss and excercise program. So, even though I had been fighting my weight my entire life, and had tried every diet and excercise program under the sun. I still had not had what they wanted. So, they denied me. Well, long story short. I got them on appeal with a technicality. Since I switched insurance at the beginning of the year there was a delay getting authorized for surgery. This new clause went into effect January 17th, so on appeal we contested that I had tried to get authorization prior to the new clause. I guess they felt that was the case because shortly after my appeal I got approval. So, for anyone else that has Aetna PPO bottom line is YOU MUST BE 100 POUNDS OVERWEIGHT, HAVE A DOCTOR DEEM SURGERY A MEDICAL NECCESSITY, AND HAVE 6 MONTHS OF DOCTOR OVERSEEN DIET AND EXCERCISE IN THE PREVIOUS 2 YEARS BEFORE SUBMITTING FOR SURGERY. Hope this helps someone else. Actually, I am glad that in the end they are paying.~ (Anastacha .) Aetna MC (MI) - 02/13/01 8/15/00 Was working on my appeal for BCN when husband's open enrollment came up at work. I researched this site and of the choices given to us, Aetna seems to be the most "surgery-friendly". In fact, a co-worker of my husband's is having the surgery in mid-November. 11/18/00 Well, I switched to Aetna. It went into effect 9/1/00. Now I'm working on approval with them. They have requested only a letter of medical necessity and the dreaded "proof of physician supervised weightloss attempts". So, I have ordered my records from my old family doctor and will put together a nice package. May take a few weeks to get the old records. Hopefully, will have it for them in about 3 weeks. 02/07/01 It's a long story..but my paperwork was finally sent to Aetna today. I'm hoping to hear I am approved soon ;) Just an approval would be nice. 02/18/01 I'M APPROVED!!!! Only took them 6 days. And there is a weekend in there! I was approved on the 13th. Found out Valentine's Day. Happy ME! (Nicole P.) ANTENA - PPO (OH) - 12/04/00 (Dottie L.) B/C B/S General Motors - Informed Choice Plan (MI) - 12/23/91 I had no problems with the insurance company for any of my surgerys. For the Tummy tuck I had to send pictures of the infection I use to get with it and I also had a hernia repair at the same time. For the modification of the T T to get rid of the ears. (Dr Sapala did not do the orginal surgery) it was done as an out patient in and out the same day and had no problem with the insurance. I also had to have my orginal surgery modified because I was on Fosamx for my bones and it tore up my pouch but there was no problem getting it done the insurance co was great for all my surgery's (Pat L.) BC & BS - Federal (KS) - 12/25/01 I was really pleased with how fast they responded back. Patty from Liv Lite sent my paperwork out for me and BC/BS replied back in 2 weeks. I was approved with my first letter. My sister was denied with her insurance...all I can tell you is to keep trying! Good luck to all. (Cody M.) BC/BS OF ROCHESTER (KS) - 01/11/01 (Jean A.) BCBS (MI) - 12/28/02 I really never had to deal with my insurance company. Dr. Wood's office took care of everything. (Dana B.) BCBS - PPO (MI) - 02/03/03 (Teresa S.) BCBS & SELECT CARE PPO (MI) - 08/27/00 BCBS / teamsters only took one week. SELECT CARE PPO / after one week requested medical records for the past six months, we sent them and had a answer 10 days later.approved by both. (Loretta D.) bcbs messa (MI) - 02/27/00 Couldnt think of anything negetive to say about this insurance. I had no problems at all. ONly took two weeks for approval. (Toni w.) BCBS-SEM - PPO () - 03/09/03 (Angela G.) Blue Care Network (MI) - 06/29/00 It took two weeks and 55 pages of information, but I am approved. (Lisa M.) Blue Care Network - HMO (MI) - 10/13/00 Approval for consultation/psych evaluation after 5 days (including the weekend!) Psych eval - phase 1 - 9/1/00. MMPI test scheduled for 9/5. So far BCN has been great. Customer reps are very helpful, providing me with all pertinent information as I request it. 9/18/00 Psych eval completed - I am considered a "highly motivated candidate" for the surgery. They say it will be a week before they have the written evaluation done and faxed to the people that need it. I WILL be calling all of them on Monday! 9/28/00 All info faxed to BCN.... 10/13/00....APPROVED!!!! I have to say that Blue Care Network has been the best to deal with....everyone is very helpful and more than willing to help if a problem arises. I can't say enough about them! (Sue R.) Blue Care Network - Blue Cross/Blue Shield/Blue Ch (MI) - 10/28/00 Once my insurance papers were sent to the right place, I was approved within a week. I called and kept finding out what was happening, and finally found out the papers went to the surgeon instead of the insurance company. But like I said, once they were received by the insurance company, I was approved. (LINDA C.) BLUE CARE NETWORK (MI) - 11/14/00 I REALLY DIDN'T HAVE A PROBLEM WITH MY INSURANCE COMPANY AT ALL. MY DOCTORS HANDLED EVERYTHING FOR ME. FROM THE TIME I STARTED LOOKING INTO SURGERY AND THE TIME I WAS APPROVED IT TOOK ABOUT 3 MONTHS AND THAT INCLUDES HAVING MY PSYCH EVLUATION, BECAUSE THEY HAD TO HAVE THAT FOR FINAL APPROVAL. (GALE W.) Blue Care Network as of 1/1/01 (MI) - 1/1/01 5-25-00 Care choices told the doctors office today that as of 1-1-00 this type of surgery is not a covered benefit. My doctor said to call the Medicial Director, that I will do tomorrow. 6-19-00 I filed a grievence against Care Choices it goes in front of the board today. They have 10 days to let me know of their decision. Anyone want to help wih the appeal letter, I don't know where to start. They supposedly have some one that helps you through this but is it just me but why help you if they are only going to turn you down. Make sense well not to me. 7-18-00 Went in front of the members reconsideration board( boy was that fun) I was turned down because of it not being a medical necessity. I have contacted HMO Task Force here in Mi. For the next step hope this doesn't take to long because I want to change insurance at open enrollment for General Motors. Maybe I could get some input as to which insurance to go with. Need Help!! 8-3-00, Went to the doctor today on a problem of left arm going numb. Talked to PCP about denial she said that she sent in a letter with the correct weight 271 instead of 217 and a letter of medical necessity. I called Care Choices, this morning talked to Tina Howie she told me the case was closed, I didn't meet the criteria and it was not a covered benefit after 1-1-00. So I will get busy with HMO task force. The lady that I need to talk to was on vacation. 11/2/00 Contacted Dr. Hares office to set appointment for after the first year. I have an appointment to talk to his nurse Jackie on Dec. 5, if everything goes okay I can set up an appointment with doctor afterwards. 1/1/01 Changed insurance to BCN 2/14/01 ALL paperwork is done & turned in to BCN now all I am waiting for is an amswer. I have a tenative surgery date of 3/2/01 if I get the approval in time. I still haven't seen the doctor so I may not make it. Nothing can be done without the approval. I'm calling them every day. 2/27/01 WOW!! Was approved. Dr. Appointment 3/2/01. Surgery 3/8/01 BCN was great. (Colleen K.) blue cross - traditional (MI) - 11/27/99 They were very efficient, and I had my approval 5 weeks after the paperwork was sent by Dr. Sapalas office. (Judy C.) Blue Cross - BCN HMO (MI) - 03/24/00 They were very helpful In my case, not at all Yes!! Yes!! (Dingwall L.) Blue Cross - Blue Cross (KS) - 02/16/02 They were very unbendable. My surgery ended up being a private pay with no insurance assistance at all. (Cathy W.) blue cross (MI) - 11/06/04 (Jessica W.) Blue Cross Blue Shield - Federal Employee Program (KS) - 12/20/00 I am working with the LivLite Weight Management Program in Junction City, KS. They have taken care of submitting a medical history and request for coverage to my insurance company. BCBS of KS does not cover this procedure, but because my insurance happens to be BCBS Federal I am covered as for any other surgery according to the limits of my policy. (Chris A. D.) Blue Cross Blue Shield Of New Jersey - indemnity (NV) - 11/14/01 (Shelley C.) blue cross- GM - traditional (MI) - 10/31/99 i sent in a detailed history of my family health from immediate to aunts, uncles, grandparents,and a detailed description of my own. I gave an in-depth view of all the diets I had been on and their success and failure and what led me to the point where i am now. I expressed my feelings about the surgery and that I felt that this was my last hope for a normal life. I included a letter from my doctor and a chart of my weigh-ins under the doctors care for the last 18+ mos. i think they were very quick to approve the surgery and i think it is very important to have the documentation that I sent. I did call once to check on the status about two weeks after it was sent in and that was a waste of time. (Margaret T.) Blue Cross/Blue Shield - PPO (MI) - 02/09/00 I really didn't have to "deal" with them, My physican's office sent the paperwork. I don't think they stalled, I was approved right away. (Debbie W.) Blue Cross/Blue Shield - Federal Employees' Plan (CA) - 3/21/03 I didn't actually deal with Blue Cross at all; Dana Estrada at Liv-Lite took care of everything for me! They wrote the letter and I was approved in LESS than one week. It was amazing! I highly recommend both Liv-Lite and Blue Cross/Blue Shield FEP when it comes to bariatric surgery! This was a total piece of cake. :) (Susan W.) Blue Cross/Blue Shield of Michigan - Community Blue PPO (MI) Did really have a problem - required diet history, psych evaluation. Approval took about 6 weeks. (Carolyn P.) Blue Cross/Blue Shield of Michigan - PPO (MI) - 06/21/00 (Jeni F.) Cigna - PPO (MI) - 12/07/99 At first it seemed like they were giving me the runaround. I got the usual, "Paperwork? What paperwork? We didn't receive any paperwork..." But after asking my doctor's office to fax it, and calling to confirm they received the fax, it took about two weeks for them to approve me. They didn't tell me why they approved me, and I was so happy, I didn't care! (Amanda H.) Cigna (OH) - 06/2000 I had no problem dealing with my insurance company they responded timely, and called it preventative surgery. (Jodi H.) Cigna - PPO (CA) - 09/30/02 My insurance company was great I was very surprised because I have had problems with them in the past. (Michelle A.) CNS Health partners (MI) - 02/09/01 These people were a breeze. They had ZERO questions! Unlike Selectcare...they were aweful! My Angel Debbie at the Michigan Weight Loss inistitute did a GREAT job!!!! My PCP office was just annoyed at what they had to do, so I do not think that helped at all either. I think if all your stuff is documented and put together well, there should be no problems! (Kimberly .) Connect Care (MI) (Jan T.) Corporate Plan Management - unknown (KS) - 11/25/00 I was ready for a fight with Corprate Plan Management after being told NO 4 years ago but there was no fight. Patty Maycroft with LivLite took information and she and the doctor (I think the doc helped) compiled a "letter of medical necessity" and it took about 5 weeks for the approval to come through. (Bev R.) Fox-Everette - PPO (MS) - 09/27/00 My contact at the insurance company was nice, if non-commital. She said that I would need a "Letter of Medical Necessity." I gave that info to the dr.'s staff and they're taking care of it. I'm waiting, but hopeful. Will update later. 12/8/00 I have had no problems at all with my insurance. Of course, all that's been filed was the approval letter, but from the experience of others in my company, I don't expect any major problems. (Lili R.) Great West - PPO (KS) - 10/20/04 It took 2 times of denial to get approved. They take a long time to get approved so I would say they like to stall. I think they finally approved me because of how persistent we were to them. Make sure you have had t least one year of doctor supervised dieting (including weekly weigh-ins). And have documented weight loss programs for the last five years. (Kelly A.) Great west life and annuity - PLAN #161470 CLASS 4 (CA) - 02/04/00 (DANA E.) Hap - Hap (MI) - 03/28/00 (Eudora R.) Harrington Health Services through Meijer - HHS PPOM () - 07/17/01 You must have completed a 6 month very low calorie diet i.e: 800 calories or Optifast for 6 months. Accompanied by seeing a registered physcian weekly, and a dietician, and an exercise Goo Roo, with a masters degree in jumping through hoops and doing backbends and flips. Then you must have one full year of follow up group therapy for example Overeaters Anonomous. This must all be done within the last 3 years! They are following Dr. C. Everette Koop's diet guidelines as outlined in his book "Shape Up America". He is the former US Surgeon General, under the Clinton administration. He has a web page: http://www.shapeup.org If you jump through all of these hoops, including a psyc evaluation. You can have the surgery no problem! They treat you like garbage on the phone, hardly ever answer your email or questions. As soon as the person who answers the phone asks "And what is this concerning?", and you say, "Bariatric Surgery"...... well the whole atmosphere changes! ......... oh yea, BMI of 35 with comorbidities. BMI of 40 with no comorbidities. I've been told over the phone: "We can do whatever we want!" "My sister-in-law had that surgery, and it don't work, she gained all of her weight back!" Ohh when I heard that, I thanked the lady and said, "Never mind, cancel my surgery request right now! Thanks for the warning!" Last note...If you appeal.......they will dig up a doctor who practices "alternative medicine", treats with aroma therapy, believes aging is treatable, is against surgery, and has links to "Wicca" (witchcraft, aka Witch Doctors) on his web page. This has all been changed as of 7/17/01. I called a televesion station in my area and they are doing a story on me. Now my employer has changed the criteria to a case by case basis, and I am covered!! I am going to start the ball rolling as soon as possible! It was a fight, but I won, and won for alot of people! Was finally approved after contacting a local television station who decided to do a story on me. Seems the insurance company got a little nervous and decided I should be approved! THANK YOU CHANNEL 7 ACTION NEWS DETROIT! (Phiddy .) Horizon Blue Cross Blue Shield of New Jersey - PPO (CA) - 01/17/04 They were outstanding! (Jilliecats .) Humana - PPOM (MI) - 04/05/1999 My insurance company at the time was excellent in approving my surgery. Humana coveres the surgery if the person is morbidly obese, no questions asked. I was told that it could take up to 2 months to hear a response, it only took 3 weeks. I've heard so many horror stories about health insurance, but, Humana was excellent in the approval status. (Dawne H.) Labor's Health &Welefare Trust - PPO (CA) - 1/18/01 The Insurance Company made me wait a long time. I had to change my Insurance Company and after my first letter, they told me that I had to have a second opinion to see if it was medically necessary. Then they gave me a hard time with processing that paperwork. I wrote down each conversation and told the lady that I wanted to speak to her supervisor. Aftr thaT it only took one day. Rick Marks with Dr Nazarian was the front end person handling my Insurance company. When I was trying on my own I was so frustrated because I did not know what I was doing. Rick did it!!! Call Dr Nazarians office in Beverly Hills, Ca if you want a wonderful, sensitive and understanding man to help you though this hard time with the insurance. (Kristine M.) Mailhandlers high Option (MI) - 12/19/00 HAD NO PROBLEM! APPROVED THE 1ST TIME IN LESS THEN TWO WEEKS (Alice W.) Medical Mutual of Ohio (OH) - 07/05/01 They have been awesome! Even though my surgeon and the hospital are in another state, and over 100 miles away, they approved my surgeon as a First Tier Provider, and the hospital is a memeber of the provider network--so no 20% co-pay for out-of-network service! They do want a 5-year history of weight, weight-loss efforts, and also want you to be at least 2x your "ideal weight." (I weigh 255 or so--just barely double the low end of my ideal weight for my height.) The surgeon only requires 100 lbs. over ideal weight. The insurance co. does not pay for toiletries (toothbrush, shampoo, etc.) or take-home meds--so I sent a letter to the surgeon letting him know I did not want those items at the hosp., also provided form and envelope for him to mail a prescription in ASAP to the mail-order pharmacy of my insurance, so I can get the meds for only $2, vs. whatever the hosp. would charge me. (I am trying to cut costs wherever I can--I am taking this leave from work UNPAID...) (Cindy W.) Not insurance - Vocational Rehabilitation Services (MS) - 10/10/00 There are vocational rehab. services in every state, covering every county... you just have to find them. If you are working and have your own insurance who has already denied the surgery and your morbid obesity related health problems are negatively affecting your work performance... They WILL PAY 100% of the surgery, doctor, after care, etc.!!!! I had never heard of there being any programs in existence like this until someone at Dr. King's office told me about it. Different county offices look at this surgery and obesity differently.. you just have to find one that has an open mind about the surgery and has paid for it in the past.. they have to let you apply, and when you do, take every medical record you can find!!! They have been so helpful to me in Lafayette County, MS. I had approval within 3 weeks!!! (Susie M.) Painters Union Insurance - PPOM (MI) - 01/28/00 (Eva B.) Painters Union Insurance Fund - ppom (MI) - 01/15/00 I was approved after the first letter, so I waited for the BTC to call me with some dates but I never heard from them, so I tryed getting ahold of them but got the run around for a couple weeks and the I finally talked to someone and they informed me that the amount that my insurance co. was willing to pay was not enough. and that since they didnt deny me, just un willing to pay the full amount! that there was nothing that they could do for me and I havent heard from anyone since. it is now 9-10-00. 11-17-00 found new Dr. It's James Sapala, Sent in letter for approval today( keep my fingers crossed ) 12-6-00 Approved once again after only three weeks. I would like to say that My Insurance Company is the greatest. (charles b.) PHP () - 06/17/00 ( .) PPOM - PPO (MI) - 06/01/99 Well at first I though I would have a difficut time sine the one insurance lady told me all I needed was to eat right and excersise I was devastated so my husband took over and gave her his toughts I won't get into that so I called my PCP and told her what this lady said and she told me not to worry she would take care of it and she did a few hours later I got approved.I had a very supportive PCP. (Nicole M.) Preferred Health Care Inc. - PPO (KS) - 01/31/02 (Pamela B.) Principal Life Ins. Co - Healthcare Preferred (KS) - 03/26/03 Patty and Pam at Liv-Lite in Junction City sent me a packet to fill out and they wrote a letter of medical necessity and sent it to the insurance company and they approved right away. I thank God for Patty and Pam. My insurance is great too!! (IHAVELOSTALOT .) Prudential HeathCare - POS/PPO (CA) - 10/25/00 I have not had to handle any of the paperwork to the insurance. My Weigh Counselor Rick Mark who works for the Weigh 2 Freedom Program is doing all of this for me. Thank God!! He faxed the request letter to the Insurance today (11/14), Rick feels very confident that I will be approved in a short matter of time. Let's hope! 11/20/00 Received a phone call confirming that I had been approved! (Konnie C.) Select Care - POS (MI) - 10/09/00 This form of Select Care does not cover out of network procedures at 100%, so don't bother dealing with the Bariatric Center in Ann Arbor if you are not willing to pay a portion of the surgery expense. (Dorothy P.) Selectcare - PPO (MI) - 12/30/00 Get as much information and support from othe doctors as possible. I had letters of recommendations by 3 different doctors my podietrist my family doctor [OB-GYN], and an orthopedic surgeon/dr. about my joint pain. You will also need 3-5 years of documented weight loss attempts. Talk with the Jackson office staff to help you with that. [ esp Debbie]. It does take along time to get all the iformation together but all in all it really did'nt take much time once the iformation was sent in. Just be persistant. (Judy H.) shield benefits - ppom (MI) - 05/31/00 They were very good to deal with. Did not stall at all once I got my paperwork to them. (judy h.) Tricare (FL) - 10/18/00 I have never received any bills - NOT ONE! I had the surgery three years ago! Tricare was wonderful, my dr.'s staff handled all of the "legwork" I never even spoke with an insurance rep. NO CO-PAY & NO DEDUCTIBLE!! (Kari P.) UFCW Union - PPO (CA) - 05/13/00 I had an answer in 2 days. No hesitation at all. No Problems. Have your Doctor write a letter saying he thinks it would help you. Also have to be atleast 100 pounds over weight with a bmi of atleast 40. (Michelle H.) UNITED HEALTH CARE (NY) - 07/22/01 THE DOCTORS OFFICE (SURGEON) WROTE A LETTER TO THEM, AND HIS NURSE SPOKE TO THEM, IT WAS APPROVED IN A MATTER OF A DAY OR SO. INSURANCE IS HARD.. IT DEPENDS ON THE PERSONS POLICY... (Theresa A.) UNITED HEALTH CARE - SELECT PLUS POS (CA) - 04/27/02 They are wonderful. I had no problems dealing with them. I had my first consultation with my surgeon April 29,2002(This monday) and The surgery was approved today May 1,2002. Took two days. They dont stall at all. No persistence needed. Rick took care of it all. (Susan ..) United Healthcare - Select Plus (KS) - 03/15/01 They set a new record. They approved in one day with only a couple of questions. Their policy is medically necessary based on 100 lbs overweight. No sweat. (Randy B.) United Healthcare - Select Plus POS (TX) - 07/15/03 I have United Healthcare and so far they have been pretty good. I am going through the Liv-Lite program. They are located in Los Angeles but host several seminars throughout California so I was able to attend a seminar in Emeryville. I'm from Yuba City so it was only a 2 hour drive. I saw the surgeon Dr. Nazarian. He's wonderful and very informative. Dana (who is an absolute doll! and so is Pam!)submitted my paperwork to the insurance right away and within 4 weeks I was approved. From what others have told me, 4 weeks is a long time for the insurance to take but I guess they are backed up a little. Anyhow, I'm all set for July 30th which is in 2 weeks!! My hubby is going to have his surgery a few weeks after me so we are in this together all the way! I hope that anyone out there reading this has success in their surgery venture and that all goes well with gaining approval from insurance. It can sometimes really set us back and try our patience but don't give up. I've been through Kaiser and PacificCare and I'm finally going to have the surgery with United HealthCare. It takes a lot of patience and persistance but don't give up! God bless you all! (D B.) UNITEDHEALTH - PPO (CA) - 11/27/00 (DIANE B.) WELLMARK BCBS OF IOWA - ALLIANCE SELECT (KS) - 04-16-01 I HAD NO PROBLEMS AT ALL IT ONLY TOOK 2 DAYS TO APPROVE. I CALLED TODAY TO SEE IF THEY HAD RECEIVED IT AND THEY SAID IT WAS APPROVED.THANK YOU!THANK YOU!WELLMARK BCBS OF IOWA AND I CAN GET THE SURGERY ANYTIME TIL OCT,18 01. (MICHELLE C.) Wellness Plan (MI) - 03/05/01 Fairly difficult dealing with this company. They denied me at first, until I got my doctor to write them a letter which said it was medically necessary. With my weight being 500 they couldnt deny it. However they told me it was denied. We fought with them until December, when someone from their office finally said..."Oh my, you have been approved since August". I was very upset, feeling that they were just hoping I would disappear. They have no bariatric surgeons in theur network so this was another battle. I had to apply to go somewhere out of network. I was set up at 2 other places when they cancelled both. I am just praying that I can get through this week before the cancel me again! (Alana F.) WEYCO INSURANCE - SELF FUNDED (MI) Had no trouble at all with the insurance company. Had approval within 15 working days after 1st letter was sent. Because this surgery could not be performed within the network I belong to, just needed that information attached to orginal consulation. All claims were processed & paid with no problems. Great insurance to work with! Update: Because this employer is self funded they no longer pay for the surgery effective Jan. 2002, they "now" perform the surgery but will not pay for their own employees to have it done!!! (Jean W.) |