| Advantage / chancellor |
|---|
| Insurer Policy |
Advantage / chancellor |
| Insurer Status | Approved after first letter (04/05/04) |
| Source |
Alan J |
| Bc/BS |
|---|
| Insurer Policy |
Bc/BS (Anthem) |
| Insurer Status | Approved after 2nd appeal letter |
| Source |
Kathy S |
| IUMG |
|---|
| Insurer Policy |
IUMG (MPlan) |
| Insurer Status | First letter sent - still waiting (04/21/05) |
| Source |
Stacey H |
| AdminOne |
|---|
| Insurer Policy |
AdminOne (PHP) |
| Insurer Status | Denied after first letter (10/16/00) |
| MD-supervised programs |
4 (31 weeks) |
| Source |
Victoria M |
| AdminOne corp. |
|---|
| Insurer Policy |
AdminOne corp. |
| Insurer Status | Denied after first letter (08/17/00) |
| MD-supervised programs |
3 (14 weeks) |
| Source |
Victoria M |
| Advantage |
|---|
| Insurer Policy |
Advantage (St. Francis Health) |
| Insurer Status | Approved after first letter (08/02/01) |
| MD-supervised programs |
2 (41 weeks) |
| Source |
James G |
| Insurer Policy |
Advantage (St. Vincent CMO) |
| Insurer Status | Approved after first letter (09/29/03) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| MD-supervised programs |
4 (127 weeks) |
| Comorbidities |
Sleep apnea, hypothyroid, insulin resistant, arthritis |
| Policy |
Must be medically necessary |
| Comments |
It took a while to hear anything. At first I thought I was going to be denied because of the medical supervision diet for 18 months. I had 12 months. They did approve me. When I got verbal approval, I persisted with phone calls between doctor and insurance co. to get all necessary information to the insurance co. |
| Source |
Joanne S |
| Insurer Policy |
Advantage |
| Insurer Status | Approved after first letter (04/11/02) |
| Source |
Candice G |
| Insurer Policy |
Advantage |
| Insurer Status | Approved after first letter (02/28/02) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
56.3 |
| Source |
Carrie R |
| Insurer Policy |
Advantage (hmo) |
| Insurer Status | Approved after first letter (06/28/02) |
| Source |
Judy H |
| Insurer Policy |
Advantage (HMO) |
| Insurer Status | Denied after 2nd appeal letter (07/12/02) |
| Source |
Christina B |
| Insurer Policy |
Advantage |
| Insurer Status | Approved after first letter (07/09/02) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
12 |
| Pre-Op BMI |
47.3 |
| Policy |
Must be medically necessary |
| Comments |
I went to my intial consultation on 7/9/02-waiting for my surgeon's office to submit my information for approval-have read my certificate of insurance and WLS is a covered benefit for Morbid obesity-must have 18 months of physician supervised dieting and 5years of weight loss documentation. I was approved after the first letter. I was approved on 10/01/02. I must say that the process seemed to be different than what I read on other profiles. I was unable to call customer service to check on the status of my claim. St.Vincent's CMO was responsible for the approval and have a process set in stone. The surgeons office could call but I could not. I did receive letters that explained the process (their letter states that the process could take up to six months or more) I was approved in approx. 90 days from consultation. |
| Source |
Renee J |
| Insurer Policy |
Advantage (ppo) |
| Insurer Status | Approved after first letter (08/20/02) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
1 |
| Pre-Op BMI |
60.8 |
| Comorbidities |
hypertension |
| Policy |
Must be medically necessary |
| Comments |
I had no difficulties with insurance. My bmi is very high and I think they based their decision mainly on that, but I know Dr. Inman sends in lots of information. |
| Source |
Carrie R |
| Insurer Policy |
Advantage |
| Insurer Status | Approved after appeal letter (05/12/03) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
55.4 |
| Comorbidities |
Sleep Apnea, GERD, Polycystic Ovarion Disease, Hypothyroidism, Asthma, Patellar Chondromelacia, Depr |
| Policy |
Must be medically necessary |
| Comments |
I was initially denied for not having met the written criteria...18 months followed by a physician...had to be monthly..and I had 10 years tri-monthly. I appealed right away..got a letter from someone I found on here to use as a base..i will share if anyone needs it. They had 15 days to respond and I had my approval in 14 days. Just waiting on my surgery date now..:) |
| Source |
Anjonette P |
| Insurer Policy |
Advantage (HMO) |
| Insurer Status | Approved after first letter (08/30/02) |
| Source |
L J L |
| Insurer Policy |
Advantage (HMO) |
| Insurer Status | Approved after first letter (10/10/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
54.7 |
| Comorbidities |
Diabetes, Hypertension, POS(polycystic ovarian syndrome), Gout (arthritis), Depression |
| Policy |
Must be medically necessary |
| Comments |
Ok, here goes...The short story is it took 3 days to get approval. Here's how it happened: My information was sent to the Managed Care Medical Director of my HMO's Network Hospital. Initially he denied my request for bariatric surgery. I was told that he wanted to see more documentation that I had been on a supervised weight loss plan for at least 18 months. I told the Managed Care Administrator who gave me the news that I challenged his denial and I wanted to appeal. I told her that I have been on just about every weight loss program out there and have been on a constant weight loss program for the last 2-3 years. I told her that my PCP has been monitoring my health closely and, based on my last labs, has discovered that I am insulin resistant and, right now, my body is not capable of losing weight by conventional means which is why he has determined that I would be a good candidate for bariatric surgery. She suggested that my PCP call the Medical Director and explain that to him to try to get the denial reversed.
I called my PCP's office and talked to my PCP's RN who said that she would tell my PCP and ask him to call the Medical Director. Not 10 minutes later my PCP's nurse called me back to say that I had been approved!!
My Managed Care Administrators definately respond to persistence. That's the only way that I have been approved. I would recommend that you make sure that you have documented your attempts at weight loss and make sure that it is documented that you have recently tried a supervised weight loss program that has failed or, as in my case, you are medically unable to lose weight. Make sure all of that information is documented. Also keep the communication lines open between your PCP, Network Administrators (if any), insurance company and bariatric surgeon/treatment center. |
| Source |
Louisa Joy L |
| Insurer Policy |
Advantage (Chancellor) |
| Insurer Status | Denied after appeal letter (11/13/02) |
| Comorbidities |
Fibromyalgia, Diabetes,GERD,Arthritis,Hiatal Hernia, chronic lymphedema (due to Breast cancer) , som |
| Policy |
Must be medically necessary |
| Comments |
They want 18 months of documented weight loss attempts with PCP. I don't have 18 months but I have tried many diets and have been unsuccessful, because I gain it back. They have been very pleasant to me on the phone. The lady in the appeals office actually called me right after the meeting to tell me that they still denied it. So now I am starting my 2nd appeal. |
| Source |
Brenda C |
| Insurer Policy |
Advantage |
| Insurer Status | Approved after appeal letter (03/07/03) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
48.2 |
| Comorbidities |
Sleep apnea,Hypertension,Diabeties type 2, |
| Policy |
Must be medically necessary |
| Comments |
I felt the the reason for denial was crazy.I was very persistent with them.I was told appeal took 2 weeks and it did just that. I guess they get an A+++ for that.They did approve it.I just want to say it looks like you have to play hardball with them so if they turn you down you have to follolw thru and let them know you are'nt just going to roll over and play dead.I have a great appeals letter for appeal # 1 and appeal # 2 if anyone would like to use it I would be glad to send it to you.Also have your appeal letter ready before you get turned down this way if you do you send out the appeal the same day of denial by fax,email,and registed mail.Dont wait for them to send you a denial letter get your phone denial and proceed with the above actions I layed out for you. |
| Source |
Michael C |
| Insurer Policy |
Advantage (PPO) |
| Insurer Status | Approved after first letter (07/23/03) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
2 |
| Pre-Op BMI |
40.4 |
| MD-supervised programs |
5 (89 weeks) |
| Comorbidities |
borderline diabetic, hypertension, had heart surgery in past etc |
| Policy |
Must be medically necessary |
| Comments |
BMI 44.1
I AM TRYING TO GET LAP BAND
To all i had another insurance company they were called CIGNA... It was a nightmare. Nothing I did was good enough for them. THEY LOST MY PAPERWORK. The left hand didnt know what the right hand was doing and didnt care. No Customer service. Well i kind of just gave up i was trying to find away to pay myself. WELL, WELL, WELL My employer just insurance providers.... Yeah.... And they approved on the first letter... I am
sooooo Thankful... I am stil a little scared/ But It will turn out ok |
| Source |
Julie T |
| Insurer Policy |
Advantage |
| Insurer Status | Denied after first letter (09/17/03) |
| Policy |
Must be medically necessary |
| Comments |
I think they stall. They lose corespondences and violated HIPAA guidelines. They require 18 months Physician supervized weight loss programs not including weight watchers or LA Weight Loss programs. You need a physicain to follow you one a month. |
| Source |
Mari F |
| Insurer Policy |
Advantage |
| Insurer Status | Approved after appeal letter (11/08/03) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
51.1 |
| Policy |
Must be medically necessary |
| Source |
David B |
| Insurer Policy |
Advantage (Franscian HMO) |
| Insurer Status | Approved after first letter (11/25/03) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
6 |
| Comorbidities |
OA, GERD, Insulin Resistant |
| Policy |
Must be medically necessary |
| Source |
Song H |
| Insurer Policy |
Advantage |
| Insurer Status | Denied after 2nd appeal letter (03/14/04) |
| Source |
Carol G |
| Insurer Policy |
Advantage |
| Insurer Status | Approved after first letter (04/13/04) |
| Weeks to approval |
2 |
| Comorbidities |
Sleep apnea, diabetes, & acid reflux |
| Policy |
Must be medically necessary |
| Comments |
Before I had my initial consultation or sent in any info to the insurance company regarding the suregery I called them by phone to discuss if they covered it & what was needed. They were very discouraging over the phone. They basically told me not to bother going to the consultation becuase it would not be covered. I fell asleep while driving & ended up at the neurologist office & she suggested I have a sleep study done. Turns out I had sleep apnea brought on by my weight. She sat me down & had a serious talk with me about the need for me to loose weight. She never mentioned having surgery. I told her I have been a member at the gym. I had been on every diet known to man & was currently in the Weight Watchers program again for the 3rd time in my life. I decided then and there that I need to take a drastic step in order to live a longer healthier life me and my 2 year old son. I went to the consultation & took all of the documents I had of previous attempts at weight loss & all of the programs I had been in. I was approved & given a suregery date with in 2 weeks. |
| Source |
Kellie B |
| Insurer Policy |
Advantage (CMO) |
| Insurer Status | Denied after first letter (06/15/05) |
| Source |
Stephanie F |
| Insurer Policy |
advantage |
| Insurer Status | Approved after appeal letter (03/09/06) |
| Surgery Type |
Laparoscopic Lap Band |
| Pre-Op BMI |
39.9 |
| Comorbidities |
Diabetes, Hypertension |
| Source |
Indy G |
| Insurer Policy |
Advantage |
| Insurer Status | Denied after first letter |
| Comorbidities |
Sleep apnea, Hypertension, Depression, Shortness of breath, Stress incontinence |
| Source |
Angela Y |
| Advantage Health |
|---|
| Insurer Policy |
Advantage Health (Group) |
| Insurer Status | Approved after first letter (8/23/06) |
| Surgery Type |
Laparoscopic Lap Band |
| Weeks to approval |
1 |
| Comorbidities |
high cholesterol |
| Policy |
Must be medically necessary |
| Comments |
Insurance was great to deal with. They actually "pre-approved" based on letter from Bariatric Doctor Weight Loss Clinic. It took me much more time to get the surgeon's office to send in the paperwork to get the "official" approval. |
| Source |
Karen W |
| Advantage Health |
|---|
| Insurer Policy |
Advantage Health |
| Insurer Status | Denied after first letter |
| Surgery Type |
Open Duodenal Switch |
| Comorbidities |
Hypertension, Depression, Shortness of breath |
| Source |
Emily S |
| Advantage Hlth Plan |
|---|
| Insurer Policy |
Advantage Hlth Plan |
| Insurer Status | Approved after appeal letter (12/11/01) |
| Source |
Evonne F |
| advantage preffered plus (medicare ppo) |
|---|
| Insurer Policy |
advantage preffered plus (medicare ppo) (ppo) |
| Insurer Status | Approved after appeal letter (06/21/05) |
| MD-supervised programs |
2 (16 weeks) |
| Source |
Kathy B |
| Aetma |
|---|
| Insurer Policy |
Aetma (PPO) |
| Insurer Status | Approved after appeal letter (12/31/03) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
42.4 |
| MD-supervised programs |
1 (16 weeks) |
| Comorbidities |
Hypertension; asthma, high cholesterol |
| Policy |
Must be medically necessary |
| Comments |
I got the initial denial after 2 weeks but it was worded as to indicate that the policy prohibited the surgery. They have always covered everything, so I called them and had to push hard to find the plan administrator who told me that the letter "wasn't completely accurate" and she recommended an appeal without actually admitting they cover surgery. I wrote a 4 page appeal letter in which I literally copied their bulletin covering WLS and responded point by point. I called at least once a week (get a contact name!) and it took almost 30 days to get approval, however it was right through Christmas and New Year's which slowed things up a bit. Overall, they were fine, but they're not really forthcoming with proper information initially and I suspect that they deny all applications on first pass. Don't be afraid to push... |
| Source |
Julia W |
| Aetna |
|---|
| Insurer Policy |
Aetna (Point of Service (POS)) |
| Insurer Status | Approved after first letter |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
1 |
| Pre-Op BMI |
34.8 |
| Comments |
Dealing with AETNA was wonderful. The first time I got approval within 48 hours.
I just applied for a revision and was again approved within 48 hours |
| Source |
Peggy B |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
57.9 |
| Comments |
I have had no problems with this and they have been wonderful in my coverage. |
| Source |
Morgan H |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (end of june) |
| Surgery Type |
Open RNY |
| Weeks to approval |
12 |
| Pre-Op BMI |
47.1 |
| Comorbidities |
arthritis, leg swelling, HBP, depression |
| Policy |
Don't know |
| Comments |
After they kept putting me off, it took a forcefull phone call from Bariatric Treatment Center to finally get an approval. My insurance gave me the run around for over a month. They would give me a date when I would know, I would call back and be told that was incorrect information.. I pleaded with them to let me know in May (it was very important for me to know at that time) but they said there was no way even though they had had the request since the middle of March. It was the end of June before I got an approval.
I had to pay $1,500 out of pocket which is my maximum plus for the pre-op eval. which the insurance didn't pay ($85) and a little for some x-rays that were over Usual and Customary charges (I think $48).
My insurance paid without hesatation and I was happy for that. |
| Source |
Susan K |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (10/07/99) |
| Weeks to approval |
12 |
| Policy |
Must be medically necessary |
| Comments |
Prior to my approval, the first letter was sent on 7/22/99. On 10/6/99, they called and said that they needed a letter from the doctor indicating the date of the consultation and the doctor's statement that "I would be an excellent candidate for WLS." What has me somewhat perplexed is that they waited 12 weeks to say this instead of requesting it with all of the other information.
This is had been a difficult waiting time. It seems that Aetna doesn't think that I've tried hard enough to lose the weight. They need documentation from any medically supervised diets. The only programs that were available were either amphatemines (sp?), Optifast (They said no because I was only 18) or Phen-Fen/Redux (which the FDA took off the market). I wrote a letter explaining that I've been battling with my weight for 24 years -- so it's just a matter of time.
The Insurance Department at Alexian Brothers has been absolutely wonderful. I may be somewhat of a pest, but they are incredibly patient. |
| Source |
Mary S |
| Insurer Policy |
Aetna (Aetna/Future Electronics, Inc.) |
| Insurer Status | Approved after first letter (8/30/99) |
| Weeks to approval |
2 |
| Comorbidities |
cronic joint pain, status post Gallbladder removal, high colesterol |
| Policy |
Must be medically necessary |
| Comments |
This insurance is through my husbands company. We have had excellent service from them. We have had all claims to date paid in a timely manner. Nothing negative to report at this time. |
| Source |
Allison D |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (08/08/00) |
| MD-supervised programs |
1 (12 weeks) |
| Source |
Tina N |
| Insurer Policy |
Aetna (Gencorp(my emoployer)) |
| Insurer Status | Approved after first letter (11/22/99) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
8 |
| Pre-Op BMI |
49.9 |
| Comorbidities |
Narrowing of the nrves lower vertabrae-weght-loss should help-MORBIDLY OBESE- Lifetime |
| Policy |
Must be medically necessary |
| Comments |
I didn't-BTC did all the work-had referal from my In-Network doctor |
| Source |
Tasey B |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (01/13/00) |
| Source |
Lyn Z |
| Insurer Policy |
Aetna (Pepsico) |
| Insurer Status | Approved after first letter (7/29/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| Pre-Op BMI |
51.1 |
| Comorbidities |
High blood pressure, Diabetes , arthritis |
| Policy |
Must be medically necessary |
| Comments |
Things went pretty smoothly the only problem was getting the paper work into the right persons hands. Had to have it faxed by the surgeons office a second time. After that it was only a few days. |
| Source |
Ron S |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (5/20/03) |
| Surgery Type |
Laparoscopic RNY |
| MD-supervised programs |
1 (16 weeks) |
| Comorbidities |
Diabetes, sleep apnea, knee pain, |
| Policy |
Must be medically necessary |
| Source |
Angie T |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (09/06/00) |
| Surgery Type |
RNY |
| Weeks to approval |
2 |
| Policy |
Must be medically necessary |
| Comments |
Aetna was great. My Dr.'s office submitted the information and fifteen days later it was approved. I did include a history of weight loss. I had been going to a weight loss clinic for almost 13 years. I was expecting Aetna to take a long time for approval because of the profiles that I had previously read on this site. However, they surprised me with the quick response. Ok...it wasn't within hours or days, but two weeks isn't bad. I was expecting 6-8 weeks. |
| Source |
Kelly |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (01/18/01) |
| Weeks to approval |
2 |
| Policy |
Must be medically necessary |
| Comments |
This company approved me very quickly. I had no problems whatsoever. |
| Source |
Cathy L |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (11/25/00) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
2 |
| Comorbidities |
arthritis, depression, hyperlipidemia |
| Comments |
They were great except the letter was directed to the wrong address to begin with and then when it finally got there, it was Christmas and then New Years, and it seemed to sit around until Jan 4th. They say there is a 24 hour turnaround, and it probably could have happened if it hadn't gone to the wrong address and then been the holidays. Yes, I would recommend it to others. |
| Source |
Susan F |
| Insurer Policy |
Aetna (Dupont) |
| Insurer Status | Approved after first letter (03/20/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
49.0 |
| MD-supervised programs |
2 (12 weeks) |
| Comorbidities |
depression, water retention |
| Policy |
Must be medically necessary |
| Comments |
They were wonderful! I was approved in 5 days, and that included a weekend! I was glad they really stayed on top of things and did not seem to let things drag. |
| Source |
Half_sammi W |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (03/25/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
12 |
| Comorbidities |
hypertension and arthritis |
| Policy |
Must be medically necessary |
| Source |
Sharrone J |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (11/19/99) |
| Surgery Type |
Open VBG |
| Weeks to approval |
6 |
| Pre-Op BMI |
70.7 |
| Policy |
Must be medically necessary |
| Source |
Laurel T |
| Insurer Policy |
Aetna (US Healthcare) |
| Insurer Status | Approved after first letter (02/18/02) |
| Surgery Type |
Open Other |
| Weeks to approval |
10 |
| Pre-Op BMI |
45.7 |
| Comorbidities |
asthma, arthritis, hypertension |
| Policy |
Must be medically necessary |
| Comments |
Dealing with insurance was frustrating. I had been approved earlier, but nobody told me. They must talk to each other there, because I kept getting different answers depending on who I talked to. You must be persistent! Just call once a week and keep track of who you are talking to. |
| Source |
Julie W |
| Insurer Policy |
Aetna |
| Insurer Status | First letter sent - still waiting (02/10/01) |
| Source |
Angie S |
