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Who might cover bariatric surgery in California?

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If you have anything to share about your insurance company or state or federal program, please do so. Just click here, sign in, and go to your “insurance information” section.

Thousands of people using the internet come to this page every week to research their insurance company or provider's record of approval for bariatric surgery for different types of patients. This information helps people adjust their expectations and can supply valuable comparison information to those faced with coverage denials. Please encourage the posters below to update their postings where this may be applicable.
These are comments posted by the public. We do not endorse or recommend any of the companies or agencies below.

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10,570 records

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Insurer Policy ( )
Insurer StatusApproved after first letter ( )
Surgery Type Laparoscopic RNY
Weeks to approval 4
Pre-Op BMI 37.8
Policy Don't know
Source Kelly S
(sharp rees-stealy medical group)
Insurer Policy (sharp rees-stealy medical group) (pacificare)
Insurer StatusApproved after first letter (032202)
Surgery Type Laparoscopic RNY - proximal
Weeks to approval 1
Pre-Op BMI 40.4
Comorbidities lowerback pain,shortness of breath,arthritis both knees,
Policy Must be medically necessary
Comments Right now everything is going good.I called my medical group just about every day to see if my file got there. this appovel letter is for my consult only.I did not give them time to stall.sharps rees-stealy medical group has been good to me over thelast 8 yrs I've been with them.so yes at this time. I would recommend them.
Source Carla R
Anthem Blue Cross of Ca 250/90/15
Insurer Policy Anthem Blue Cross of Ca 250/90/15 (PPO)
Insurer StatusApproved after first letter (4/07/2008)
Surgery Type Laparoscopic RNY
Comorbidities Depression, Shortness of breath, Stress incontinence
Policy Must be medically necessary
Comments I can hardly believe that the approval went so fast and easy. Had my Consult 3.5 weeks ago. Had nutritionist consult the same day as surgeon consult and Psychiatric Eval 2.5 weeks ago. I think once my surgeons office submitted everything Blue cross only took a couple of days to approve it! VERY FAST. My BMI was 40 with no serisous comorbidities. I highly Recommend Anthem Blue Cross PPO. I have had Blue Cross in the past and was so happy to be able to have this insurance again.. They are very easy to deal with.
Source Dona S
blue cross
Insurer Policy blue cross
Insurer StatusDenied after first letter (07/05/06)
Comorbidities GERD, Arthritis, Hypertension, Depression, Shortness of breath, Stress incontinence
Source Grace M
Blue Shield
Insurer Policy Blue Shield (HMO)
Insurer StatusFirst letter sent - still waiting (06/23/05)
Source Shauna S
Kern Family Health Care
Insurer Policy Kern Family Health Care
Insurer StatusApproved after first letter (8/6/04)
Surgery Type Open RNY - proximal
Pre-Op BMI 51.3
Comments I didn't have to do a thing, they submitted my request for me on Monday August 1st and I had a yes before noon on Friday the 6th. So Wonderful.
Source Shellie S
Lina M Fries
Insurer Policy Lina M Fries (Sutter Regional)
Insurer StatusApproved after first letter (07/25/03)
MD-supervised programs 3 (20 weeks)
Source Linda F
New Horizons-IEHP
Insurer Policy New Horizons-IEHP
Insurer StatusApproved after first letter (05/30/02)
Surgery Type Open RNY - distal
Pre-Op BMI 52.9
Source Lisa S
,\ MRMIP
Insurer Policy ,\ MRMIP
Insurer StatusApproved after first letter (06/09/02)
Source Joanna R
0
Insurer Policy 0
Insurer StatusDenied after appeal letter (05/28/04)
Source Judy S
Admar
Insurer Policy Admar (PPO)
Insurer StatusApproved after first letter (10-22-02)
Weeks to approval 1
Pre-Op BMI 41.0
Comorbidities Sleep Apnea, hypertension, severe depression.joint pain.headaches.
Policy Must be medically necessary
Comments Dealing with them is great they want to take care of my case and have have given me a fax number to give to the dr's office so they can review it and approve and or deny in 24-48 hours the drs ofc moves slowly (I know they have many patients But comeon already write the LMN and send over the paperwork) harder to work with the office staff than ins co.But that is to be expected in a big bariatric group, My insurance went out of thier way to help me any way they could by calling me with updates,The one rep Cheynne even got to know me by name and sound of my voice, those girls in utah are the best !!! I do however decline to give the name of my employer. Thank you for your understanding
Source Susan W
Advantek
Insurer Policy Advantek (PPO)
Insurer StatusApproved after first letter (05/24/04)
Surgery Type Laparoscopic RNY - proximal
Pre-Op BMI 39.1
Source Jane K
Insurer Policy Advantek (interplan)
Insurer StatusApproved after first letter (01/10/05)
Surgery Type Laparoscopic RNY
Weeks to approval 1
MD-supervised programs 2 (24 weeks)
Comorbidities no co-morbidities, but am 100lbs overweight bmi 41
Policy Must be medically necessary
Comments I really expected them to deny me at first, I was shocked when they okayed me in just 1 week...
Source Karen F
Advantek Benefit Administrators
Insurer Policy Advantek Benefit Administrators (CHP A)
Insurer StatusApproved after first letter (01/07/03)
Surgery Type Laparoscopic RNY - proximal
Weeks to approval 10
Pre-Op BMI 46.6
Comorbidities No co-morbidities needed if over 40 bmi - I was 46 bmi
Policy Must be medically necessary
Comments They were really nice to deal with and very persistent. It took about 3 weeks for them to call to let me know I needed a psych eval. And it took about 3 weeks to get an appointment for that. Otherwise the process was VERY easy.
Source Darcy A
Insurer Policy Advantek Benefit Administrators (ppo)
Insurer StatusApproved after first letter (11/19/02)
Surgery Type Laparoscopic RNY
Policy Must be medically necessary
Source Keshia G
Insurer Policy Advantek Benefit Administrators (ppo)
Insurer StatusApproved after first letter (01/19/03)
Weeks to approval 1
Policy Don't know
Comments It only took 2 days. The insurance contacted me immediately with an authorization number. It was quicker than I had ever expected.
Source Melissa
Adventist Health
Insurer Policy Adventist Health (CaliforniaCare)
Insurer StatusApproved after first letter (8/15/04)
Weeks to approval 3
MD-supervised programs 4 (81 weeks)
Comorbidities Hypertension,Type 2 Diabetes, Gerd, Arthritis, Chronic Pain
Policy Must be medically necessary
Comments The staff at Lite Demensions in Fountain Valley California is very experienced and did everything right the first time. Getting to the initial consult. was a bigger challange. Get educated so you can help your Primary care Physician do it right the first time. Blue Cross got right on board immediatly. I met all of their qualifications; diet history, co-morbids and weight etc... Make sure your Primary knows how to present the information to Blue Cross or whoever to save time.
Source Kathleen S
Insurer Policy Adventist Health (EPO)
Insurer StatusApproved after appeal letter (05/26/02)
Surgery Type Open RNY - distal
Weeks to approval 16
Pre-Op BMI 61.8
Policy Must be medically necessary
Comments I was sure they would deny me their policy on surgery was very confusing. Of course they denied my intial request. My PCP was no help. I wrote a 4 page letter to the insurance company, called them a couple weeks later they had not heard yet. They stalled for about 3 to 4 months, I called them every 2 weeks just to let them know I was there. Though they stalled the people I dealt with were nice polite and as helpful as they could be. I needed no prior formal diet history which is nice. Except for the wait they were easy to deal with.
Source Patti S
Insurer Policy Adventist Health (CCN)
Insurer StatusApproved after first letter (06/23/02)
Surgery Type Laparoscopic RNY
Weeks to approval 2
MD-supervised programs 1 (24 weeks)
Comorbidities Gerd-lower back pain-bone spurs in heels-sholder pain
Policy Must be medically necessary
Comments My coordinator sent my paperwork in on the 25th of August 25th, I found out on September 11 that I was approved. Two calls is all it took. One in the AM, and another in the afternoon, because the paperwork had not gotten back. I didn't have any problems getting information from them. Deanna the coordinator is the best!!! Following surgery I got my bill, and was very upset. I was not told that I was going to have to pay as much as I have to. Not even an estimate was given. I am not very happy with the insurance at this time, and have cancelled all the insurance from my Co. I am now on my Husbands.
Source Melody D
Insurer Policy Adventist Health
Insurer StatusDenied after first letter (11/23/02)
Comorbidities Fatty Liver, Hypertention, Hypothyroid, pain in joints mostly Knees and feet.
Policy Written exclusion policy
Comments they are very nice to deal with, believe the deny everyone at first. Have to write appeals letter to them with my primary care physican writting one too. I know for a fact that they have paid for the procedure for a lot of people in the last few years. Write that appeals letter and go for there.
Source Kathy Z
Insurer Policy Adventist Health
Insurer StatusApproved after first letter (11/04/04)
Surgery Type Open RNY
Pre-Op BMI 39.6
MD-supervised programs 1 (16 weeks)
Comorbidities GERD
Policy Written exclusion policy
Comments CCN has an exclusion in their policy regarding obesity care but since Pacific bariatrics stated it was a medical necessity and stated that I was "morbid" obese. They approved me after the first letter and they were very helpful and expediant (2 weeks). They definitely respond to persistence. I called them 3-4 times a week along with the help of Dedra at Pacific Bariatrics.
Source Loretta M
Insurer Policy Adventist Health (HMO)
Insurer StatusApproved after appeal letter (12/09/03)
Surgery Type Open RNY
Pre-Op BMI 49.5
Source Missy G
Insurer Policy ADVENTIST HEALTH
Insurer StatusDenied after first letter (07/27/06)
Comorbidities Chronic skin conditions, Depression
Source Sadie S
Aetna
Insurer Policy Aetna (Aetna US Healthcare HMO and PP)
Insurer StatusApproved after appeal letter
Surgery Type Duodenal Switch
Source Debbie W
Insurer Policy Aetna (Aetna US Healthcare HMO and PP)
Insurer StatusApproved
Comments It seemed to take so long to get approval from this company. I got the
Source Wendy D
Insurer Policy Aetna (BGI)
Insurer StatusApproved
Source Kelly G
Insurer Policy Aetna
Insurer StatusApproved
Source Karen J
Insurer Policy Aetna (AEACU)
Insurer StatusApproved
Comments First denied to do incorrct coding - apparently their are two codes my particular plan covers - make sure Roux En Y is the most prominently stated objective in the code description.
Source Lorrilynn C
Insurer Policy Aetna
Insurer StatusExclusion
Surgery Type Open RNY
Source Annette G
Insurer Policy Aetna
Insurer StatusApproved after first letter
Source Bob M
Insurer Policy Aetna
Insurer StatusApproved after appeal letter (8/10/99)
Surgery Type RNY
Weeks to approval 1
Comorbidities swelling lower joints and legs
Policy Don't know
Comments It seems that my insurance company has swing with the approval board when it comes even to referrals. I feel that you are going to be automatically denied on the first attempt. I have comprised an appeal letter and am going to submit it this week and ask for a expidited response. The reason for denial seemed aimed more toward guaranteeing a source of funds than anything else They said they needed to have a 1 year doctor supervised diet program including weekly visits with the medical groups doctor. I don't even think it would have been approved with a similar diet program from another group. They just wanted more money at the expense of my health. I feel the appeal letter I submitted is a strong letter and my physical condition should demand imediate approval BMI 73.9 Weight 530 but you never know I will keep updating as I get new information
Source Jeff J
Insurer Policy Aetna
Insurer StatusDenied after first letter
Policy Must be medically necessary
Source Julie A
Insurer Policy Aetna
Insurer Status
Surgery Type Laparoscopic RNY
Pre-Op BMI 45.4
Comments Surgeons office advised me right up front that my insurance would not cover my surgery. I was not yet experiencing very many health problems related to my weight. I decided to self pay rather than fighting my insurer.
Source Linda W
Insurer Policy Aetna (POS)
Insurer StatusApproved after first letter (8/14/00)
Surgery Type Laparoscopic Duodenal Switch
Weeks to approval 3
Comorbidities High Blood Pressure, Joint Pain and Family History of Heart Disease and Diabeties
Policy Must be medically necessary
Comments 9/14/00 Let me just say it has been interesting. My PCP for some reason sent me to a non-network surgeon. I only just found that out. Because of that my surgeons office can not do the pre-certification. My PCP's office has to do that. Then Aetna kept saying they had not gotten the pre-certification information from my PCP and my PCP said they did. This went on for 4 days with me calling back and fourth. Finally today 9/14/00 I find out Aetna indeed has the information and I am now waiting for approval or denial. My surgery is scheduled for Sept. 25th so I will need to find out soon. I will keep you all posted on my journey. 9/22/00 My surgery date of 9/25/00 is canceled due to the surgeon not being a network provider. I have been approved but because he is a non-network provider it is only at 50%. So I am still waiting to see if they will pay at the higher percent. Also, while I am waiting, I have an appt. with Dr. Robert Rabkin on Monday, Sept. 25th and another one with Dr. Mark Vierra. Just in case they really won't pay at a higher rate for Dr. Patti at least I know I am approved. I just have to decide if I will go with Dr. Rabkin or Dr. Vierra. What a complete drag this whole process has been. It would have been smooth sailing if my PCP had sent me to a network provider. Word to the wise is even though your PCP gives you a referral, double check to make sure the dr. you are being sent to is a provider in your network. Wish me luck and I will certainly keep you posted when I have a new date scheduled. I have a confirmed surgery date of Dec. 13, 2000 with Dr. Rabkin. It took 3 weeks for this approval. Yippie. It has been a long haul for me but definitely worth it. To those of you struggeling with insurance approval. Don't give up. Fight and be diligent. It is sad we must go through this but if you really want it, don't give up the fight. God bless and I will post again after surgery. As I approach my one year anniversary for WLS, I am happy to announce I am down from 274 lbs. to 160 lbs. and feel wonderful! I can't believe a year ago I was suffering from being MO. I am now under 150 lbs. and feeling great! This surgery was the best thing I could have done for myself.
Source Linda D
Insurer Policy Aetna
Insurer StatusApproved after first letter (05/10/00)
Surgery Type Laparoscopic RNY
Weeks to approval 2
Pre-Op BMI 52.2
MD-supervised programs 1 (12 weeks)
Policy Must be medically necessary
Comments Aetna is great to deal with. I was approved on only the letter from the hospital. I recomend them to anyone wanting the surgery
Source Leslie R
Insurer Policy Aetna (XCLYMO10)
Insurer StatusApproved after first letter (12/10/99)
Surgery Type Open RNY
Weeks to approval 3
Pre-Op BMI 50.3
Policy Must be medically necessary
Comments IT WAS VERY EASY THEY DID NOT STALL AT ALL YES ONCE YOUR DOCTOR SENDS THE PAPERWORK IN - CALL AFTER ABOUT 10 DAYS AND CHECK IF IT HAS BEEN REVIEWED. IT FORCES THEM TO BRING YOUR FILE TO THE TOP OF THE PAPERWORK AND WORK ON IN. IN MY CASE I HAD 3 TIER LEVEL, HMO, POS AND PPO. THEY APPROVED IT ON THE PPO AND THEN I MADE THEM CHANGE IT TO THE POS. I NOW ONLY HAVE A $500 DEDUCTABLE AS OPPOSED TO A $4500 OUR OF POCKET WITH MY CO-PAY. ONCE THEY HAVE APPROVED IT ON THE PPO DUE TO MEDICAL NECESITY, THEY CANNOT SAY THAT IT IS NOT MEDICALLY NECESSARY UNDER HMO
Source Shanna H
Insurer Policy Aetna (Open Choice PPO - AEA)
Insurer StatusApproved after first letter (12/08/99)
Surgery Type Open Duodenal Switch
Pre-Op BMI 59.3
Comorbidities GERD, joint disease, asthma, degenerative disc
Policy Must be medically necessary
Source Nancy G
Insurer Policy Aetna (PPO)
Insurer StatusApproved after appeal letter (11/17/99)
Surgery Type Laparoscopic RNY - proximal
Comments It was HORRIBLE. Stall, stall and more stalling. I couldn't get ANYONE on the phone to make any sort of move. Next week...next week...they just went home...try again...
Source Polly F
Insurer Policy Aetna (Open Choice)
Insurer StatusApproved after first letter (05/99)
Surgery Type Laparoscopic Other
Weeks to approval 4
Pre-Op BMI 49.9
Comorbidities joint pain, incontinence, sleep apnea, diabeties, possible heart issues
Policy Must be medically necessary
Comments There were no problems with the Insurance company. The Alvarado Clinic pretty makes sure all the bases are covered before they send out the first letter requesting permission to perform the surgery. By following their guidelines, I was approved at the first go around. My regular doctor wasn't too supportive and wouldn't write a letter to support the surgery; my psychatrist and nutritionist were more than willing. I also called the insurance company to ask them what their policy was for my group insurance; it might be different in other policys.
Source Catherine C
Insurer Policy Aetna (Open Choice)
Insurer StatusDenied after first letter (11/28/99)
Surgery Type Laparoscopic RNY - proximal
Pre-Op BMI 54.7
Comorbidities none but hypertension is borderline
Policy Must be medically necessary
Comments 12/99 I called them to check out what they would cover and they said since Dr. Wetter is in network, they would pay 90%! We'll see if I get approved :). If he was out of network, it would be 80%. They were able to tell me where I could go for the gall bladder Ultrasound and also for the blood test.
Source Sherra B
Insurer Policy Aetna (EPO)
Insurer StatusApproved after first letter (12/07/99)
Surgery Type Open RNY
Weeks to approval 2
Comorbidities hypertension;arthritis
Policy Must be medically necessary
Comments Aetna was fairly easy to deal with. I expected more resistance. Their basic policy requirements is that your BMI is over 40 and you have proof you have tried physician supervised diets before. If your BMI is under 40, you must present evidence of other medical problems as a result of your weight.
Source Sonia S
Insurer Policy Aetna (HMO)
Insurer Status (01/07/00)
Surgery Type Open RNY
MD-supervised programs 1 (3 weeks)
Source Shannon W
Insurer Policy Aetna (PPO)
Insurer StatusApproved after first letter (08/09/00)
Surgery Type Laparoscopic Duodenal Switch
Weeks to approval 3
Pre-Op BMI 41.6
Comorbidities hip displaysia, degenerative arthritis, asthma, gastroesophageal reflex, urinary stress incontinence
Policy Must be medically necessary
Comments They are reluctant to commit and my Dr said the pre approval letter is the lamest he has ever seen. I had a very extensive medical history and a life long history of my weight from age 8, and my Dr who recomended the surgery wrote an additional letter that said what they needed to hear, so they were pretty quick about it.
Source Stacy T
Insurer Policy Aetna (PPO)
Insurer StatusApproved after first letter (01/27/00)
Surgery Type Open RNY
Pre-Op BMI 50.9
MD-supervised programs 4 (30 weeks)
Source Michele D
Insurer Policy Aetna (PPO)
Insurer StatusApproved after legal action taken (02/01/00)
Surgery Type Open Duodenal Switch
Weeks to approval 2
Comorbidities Back pain, shortness of breath
Policy Must be medically necessary
Source Kim B
Insurer Policy Aetna (Open Access)
Insurer StatusApproved after first letter (02/07/01)
Surgery Type Open RNY
Weeks to approval 6
Pre-Op BMI 49.4
MD-supervised programs 2 (50 weeks)
Comorbidities Hypertension, Diabetes
Policy Must be medically necessary
Comments Switched insurance companies effective 12/01/00. Resubmitted paperwork, faxed to WEight for Life on 12/11. They faxed to Aetna on 12/21. Checked on 12/28 and 12/30 and I'm told that they have to refax to Aetna, my ppwk has been misplaced. 02/07/01 I'm approved!! I can't believe it, I've been calling daily for the last three weeks. I've been told daily that determination had not been made, it was still under review. I thought this was never going to happen. Now, I'm in a race to get all of my pre-testing out of the way before surgery in 12 days!
Source Barbara J
Insurer Policy Aetna
Insurer StatusApproved after first letter (02/05/00)
Surgery Type Other
Weeks to approval 1
Pre-Op BMI 57.8
Comorbidities hi cholesterol, neruitis, arthritis, asthema, GERD
Policy Must be medically necessary
Comments I haven't had to deal with them, other than to find a referral to my surgeon. Pleasant for the most part. Am in shock that it was reviewed and approved so fast. ============================= Two+ years gastric bypass post-op: now seeking abdominaplasty. Stanford's Plastic and Reconstructive surgery dept. (Angelina Lopez) is most excellent. By a fluke, I again have Aetna, and they have approved abdominaplasty, with one letter from Dr. and we are still awaiting news on other skin removal approval we've requested... For now, am thrilled that I can have the TT surgery on 8/2/02!
Source L S
Insurer Policy Aetna
Insurer StatusApproved after legal action taken (09/07/99)
Surgery Type Laparoscopic Other
Weeks to approval 28
Pre-Op BMI 44.3
MD-supervised programs 1 (25 weeks)
Comorbidities Sleep Apnea, High Cholest
Policy Don't know
Comments Aetna was terrible to deal with. They seemed to do everything possible to stall. I believe that the only reason that I finally was approved was because I was very agressive and never let the issue die. I believe that the only way to deal with a difficult insurer is to be persistent.
Source Frank Q
Insurer Policy Aetna (Open Choice)
Insurer StatusApproved after first letter (04/27/00)
Surgery Type Open Duodenal Switch
Weeks to approval 6
Pre-Op BMI 55.1
MD-supervised programs 1 (16 weeks)
Comorbidities sleep apnea, gerd, osteo arthritis, fibromyalsia, asthma
Policy Must be medically necessary
Comments They were okay. They seemed to stall at first, but I pushed and pushed and finally got the answers I wanted. The only thing I can say is don't accept no for an answer and don't let them off the hook until you hear what you want to hear. And...ALWAYS get the name and phone number/ext. of the person you last talked to and keep track on notes of each conversation you have with them so you use them in future conversations.
Source Mindy S
Insurer Policy Aetna (PPO)
Insurer StatusApproved after appeal letter (10/00)
Surgery Type Laparoscopic RNY
Pre-Op BMI 55.8
MD-supervised programs 3 (50 weeks)
Policy Must be medically necessary
Comments This has been awful - they turned me down, even though my BMI is well over - and they say I dont have a proven history of medically supervised failures. Isnt that just BS??? Anyway, I sent a letter with a list of every diet I've been on, and a letter from my doctor. So - if you have Aetna, get this information sent in with your surgery ppwrk. Wish me luck... 10/00 - Well, it looks as though the shocking list of all the diets I've been on worked... I'M APPROVED!!!
Source Amy R

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