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Who might cover bariatric surgery in North Carolina?

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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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2,967 records

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1st Health of the Carolinas
Insurer Policy 1st Health of the Carolinas
Insurer StatusApproved after first letter (2/28/2007)
Surgery Type Laparoscopic RNY
Pre-Op BMI 60.2
Comorbidities sleep apnea, arthritis, BMI over 40, stress incontinence
Policy Must be medically necessary
Comments I was approved in 1 day. You have to be approved for the surgery before they will approve your endoscopy that is required by Dr Mitchell 2 weeks before surgery.
Source Donna R
A
Insurer Policy A
Insurer StatusApproved after first letter (09/23/02)
Surgery Type Laparoscopic RNY
Source John T
Access Medical
Insurer Policy Access Medical
Insurer Status (12/03)
MD-supervised programs 1 (3 weeks)
Source Amanda P
ACCORDIA
Insurer Policy ACCORDIA (ACCORDIA)
Insurer StatusApproved after first letter (06/24/02)
Surgery Type Open VBG
Pre-Op BMI 48.7
MD-supervised programs 1 (3 weeks)
Comorbidities ARTHRITIS, BACK PAIN,
Policy Must be medically necessary
Comments I HAD NO DEALINGS WITH THEM THE JOAN AT THE DR,S OFFICE TOOK CARE OF EVERYTHING.
Source Norma H
Accordia National
Insurer Policy Accordia National
Insurer StatusApproved after 2nd appeal letter (07/18/06)
Surgery Type Laparoscopic RNY
Weeks to approval 12
Comorbidities Sleep apnea, Diabetes, Hypertension, Depression, Shortness of breath, Stress incontinence
Policy Don't know
Comments It was very hard dealing with this insurance company. The wording of my policy was what the hold up was. They insisted that I have a letter from my Internest stating all my diet attempts. I had several letters from other physicians, other surgeons I thought about using etc. I had to consult a lawyer about the wording and tell Accordia that I was willing to take the steps to get this approved. After that talk and several phone calls I was finally approved. I would recommend people with Accordia read and re read the policy on Gastric Bypass Surgery and learn it. Do everything they tell you and keep track of all the phone calls and who you talked to. Make sure that if you have to appeal that the same reviewer doesn't do the appeal (that happend to me). From what I understand that same person can not re review it because they are not bias. Keep being persistant and push them to give you the answer as to why you need to appeal and keep after them.
Source Karin U
acorda
Insurer Policy acorda (carl pulliam)
Insurer Status (08/27/05)
Source Linda P
Acordia
Insurer Policy Acordia
Insurer StatusApproved after first letter (01/30/00)
Surgery Type Laparoscopic RNY - proximal
Weeks to approval 3
Pre-Op BMI 49.4
Comorbidities Type II diabetes, hypertension, GERD, chronic back and joint pain, fibromyalgia, stress incontinence
Policy Must be medically necessary
Comments I was also covered by my husband's insurance, CIGNA. They, too, responded favorably within 3-4 weeks of the first letter. It was a pleasure to deal with both insurance providers. They did not stall, and the case managers were always gracious and extremely helpful.
Source Diana T
Insurer Policy Acordia
Insurer StatusApproved after first letter (04/04/2001)
Surgery Type Laparoscopic RNY - distal
Weeks to approval 20
Pre-Op BMI 52.3
Policy Must be medically necessary
Comments I did have to wait what seemed forever to finally get approval from my insurance company, but to their defense most of that was waiting on the surgeons office to send the insurance company more information that they had requested to prove medical necessity.I sent in my pre-approval the first week in November and finally heard today,4/4/01. I called the insurance company at least twice a week and they were always nothing but considerate and patient with me and my questions.
Source Rebecca
Insurer Policy Acordia
Insurer StatusApproved after first letter (03/13/01)
Surgery Type Open RNY
Pre-Op BMI 55.6
Source Cynthia B
Insurer Policy Acordia (PPO?)
Insurer StatusApproved after first letter (04/14/01)
Surgery Type Laparoscopic RNY - distal
Weeks to approval 20
MD-supervised programs 4 (170 weeks)
Comorbidities Sleep Apnea, Fibromyalgia, Reflux Esophagitis, Hypercholesterolemia, hig risk for DM
Policy Must be medically necessary
Comments Slow process but can be quickened with persistance. They stall a great deal. My initial letter was sent by Dr. Soufa in August 2000. Once I got a surgeon on board that was certified to perform the procedure he sent a detailed letter and approval was immeadiate to his letter. It was faxed to them on February 24, 2001 and I was granted approval on March 4, 2001
Source Christine W
Insurer Policy Acordia
Insurer StatusApproved after first letter (11/27/01)
Surgery Type Open RNY
Weeks to approval 2
Pre-Op BMI 67.9
Comorbidities sleep apnea, hypertension, congenital hip deformity, arthritis, reflux
Policy Must be medically necessary
Comments I didn't have to do anything. Dr. Proctor has all of their procedures and requests so well taken care of it only took 2 weeks to get approved. Although I did call and speak with my insurance representative a few times, I still didn't have to deal with them myself. The only delay was the girl at Dr. Proctors office didn't talk directly with my representative and got some conflicting information and had to have my rep. fax her something in writing stating the percentage to be covered.
Source Karen F
Insurer Policy Acordia
Insurer StatusFirst letter sent - still waiting (07/24/02)
MD-supervised programs 1 (8 weeks)
Source Jerry M
Insurer Policy Acordia (PPO)
Insurer StatusApproved after first letter (10-10-2003)
Surgery Type Laparoscopic RNY - distal
Weeks to approval 1
Pre-Op BMI 46.2
MD-supervised programs 5 (65 weeks)
Comorbidities hypertension, gerd, hiatal hernia, fibromyalgia, arthritis
Policy Must be medically necessary
Comments I had no difficulties to report, I was approved after just 4 days. I recommend to see what your insurrance requires for your paperwork, pre surgery. That is what enabled me to be approved so fast, I had everything ready for the insurrance company, so there was no hold ups of them needing more information.
Source Shana F
Insurer Policy Acordia
Insurer StatusApproved after appeal letter (11/27/03)
Surgery Type Laparoscopic RNY - proximal
Weeks to approval 7
Pre-Op BMI 51.2
Comorbidities sleep apnea,diabetes-insulin dependant,elevated bp,high chol,,asthma, activity intolerance,foot pain
Policy Must be medically necessary
Comments Was told by my HR person at work "I'll just twll you-we've never approved it" Contact with the insurance comp. went well because I was polite and kept calling back. Made sure I called the same person(get her name and write it down),was friendly,asked her help officialy. Because of a history at work of insurance provider changes plus different primary care providers,I had 75 pages of medical history sent to them for information. My first denial was for"no effidence of DR and/or Dietitican controlled weight loss attempts" When I called,the insurance person zzi talked to said they had 45 pages! Took 7 wks to get approval.
Source Kathie B
Insurer Policy Acordia (PPO)
Insurer StatusApproved after first letter (05/10/04)
Surgery Type Laparoscopic RNY
Weeks to approval 2
Pre-Op BMI 46.2
Comorbidities Hypertension, arthritis, GERD,
Policy Must be medically necessary
Comments The Bariatric Program Coordinator at Mission Hospitals where I had the surgery, Diana Fischer, was paramount in handling the insurance company for me. She provided me with all the information that I needed and I had zero problems with the insurance company. Their response was very timely. I would definitely recommend Acordia to others.
Source Sheri R
Insurer Policy Acordia
Insurer StatusApproved after appeal letter (05/29/04)
Surgery Type Laparoscopic RNY - proximal
Pre-Op BMI 45.9
Source Joyce D
Insurer Policy Acordia
Insurer StatusApproved after first letter (03/22/04)
Weeks to approval 3
Comorbidities ARTHRITIS,HBP,DM,SLEEP DISORDER,
Policy Must be medically necessary
Comments THEY WERE VERY KIND.NONE.YES.CALL IF DEADLINE HAS PASS FOR RESPONDS.
Source Judy M
Insurer Policy Acordia
Insurer StatusApproved after first letter (10/27/04)
Surgery Type Laparoscopic RNY
Pre-Op BMI 44.1
Comorbidities uncontrolled bladder, GERD, joint pains
Policy Must be medically necessary
Comments WOW!!! To my surprise, I was approved the first time I submitted to insurance. I have had absolutely NO problems with Accordia so far. I couldnt be happier with them
Source Jill R
ACS Consulting
Insurer Policy ACS Consulting (Interpane Glass)
Insurer StatusApproved after first letter (07/01/02)
MD-supervised programs 1 (8 weeks)
Source Stephanie H
Aetna
Insurer Policy Aetna (ppo)
Insurer StatusApproved after 2nd appeal letter (2-2001)
Surgery Type Open RNY
Weeks to approval 2
Pre-Op BMI 60.4
Comorbidities sleep apnea, borderline diabetic, high blood pressure
Policy Must be medically necessary
Comments Hopefully this will help others go through the insurance war. I filed for 6 weeks or more. The insurance carrier , at first, could not find my filing. I faxed a new copy to them After 2 weeks, they could not find it again, they said they sent it to another dept, since it required overnight stay. Thankfully I talked to someone who cared! They set it up to file through the RN, and 2 days later, I was approved! It will save a lot of time and heartache to go through the right channels the first time. Also, another reccomendation is to send it with a signature required for reciept. Good Luck, Kevin P.S. I found out my surgeon, Dr. Rutledge was doing an outdated surgery, and had to go through the whole process again. It was much easier through The Bariatric Treatment Center. They were really great!
Source Kevin B
Insurer Policy Aetna (HMO)
Insurer StatusApproved after first letter (06/21/00)
Surgery Type Laparoscopic RNY
Weeks to approval 2
Pre-Op BMI 50.9
MD-supervised programs 3 (82 weeks)
Comorbidities None
Policy Must be medically necessary
Comments They have kicked back several claims. Ex. Claiming my primary care Dr. did not submit the pre-certification referral to my surgeon which he did. So after a few faxes I think it is covered. Since my first attempt succeeded, I would definitely recommend them. I will update as claims get paid or rejected throughout the process.
Source Laurie D
Insurer Policy Aetna (QPOS)
Insurer StatusApproved after first letter (06/26/00)
Surgery Type Laparoscopic RNY - proximal
Weeks to approval 1
Pre-Op BMI 47.0
Policy Must be medically necessary
Comments Aetna approved my surgery in 48 hours. They approved an in network surgeon and said I could use out of network benefits to see Dr. Champion. I appealed the decision on the grounds that there were no in network surgeons who performed the lap RNY which had been approved. In 10 days I received a call that the appeal had been approved. They agreed to pay for the procedure in network using Dr. Champion. The entire insurance process took a little under 3 weeks. Not bad to get 100% coverage.
Source Laura S
Insurer Policy Aetna (Managed Choice)
Insurer StatusFirst letter sent - still waiting (08/17/00)
MD-supervised programs 1 (24 weeks)
Source Tim W
Insurer Policy Aetna (MC)
Insurer StatusApproved after first letter (08/25/00)
MD-supervised programs 3 (67 weeks)
Source Michelle J
Insurer Policy Aetna
Insurer StatusApproved after first letter (06/13/01)
Surgery Type Open RNY
Weeks to approval 1
Pre-Op BMI 44.3
MD-supervised programs 3 0
Comorbidities GERD, arthritis, high cholesterol, sleep apnea
Policy Must be medically necessary
Comments Excellent, doctor staff sent info in and I was approved within 4 days. I had definite medical conditions related to weight and had definite history of 3-4 physician followed diets/methods. It seems to me that Aetna is one of the best for approving this surgery after reading the web site and according to my doctor's office. She was relieved when I said Aetna!
Source Molly S
Insurer Policy Aetna (MC (Managed Choice))
Insurer StatusApproved after first letter (01/10/01)
Surgery Type Open Duodenal Switch
Weeks to approval 2
Pre-Op BMI 67.3
MD-supervised programs 1 (16 weeks)
Comorbidities Sleep apnea (which has caused atrial fibrillation), DJD in both knees, plantar fascitis, brawny edem
Policy Must be medically necessary
Comments 8/23/01 ~My surgeon's office sent an approval request for a Duodenal Switch, and it was rejected. I have now been approved for an open RNY. The whole process only took a few weeks, but I plan to appeal and plead a case for the DS.

9/19/01 ~I've sent a well-researched appeal letter, and am eagerly awaiting a response.

10/04/01 ~ Still waiting to hear from Aetna. Surgery date has been postponed (there are other factors involved, too). I'm SO TIRED of waiting!

1/10/02 ~ Aetna denied my appeal for a DS, but they'll still cover the RNY. Not good enough! I WILL be having my DS on 2/25/02 and Aetna can go pound sand!

Source Mary M
Insurer Policy Aetna (Managed Care)
Insurer StatusApproved after first letter (02/23/01)
MD-supervised programs 2 (122 weeks)
Comorbidities Sleep Apnea, Heart Disease, Arthritis, asthma
Comments My physician got approval in one phone call and a faxed letter. I called just to validate I wanted it.
Source Terrance M
Insurer Policy Aetna (PPO)
Insurer StatusApproved after first letter (10/6/00)
Surgery Type Laparoscopic Other
Weeks to approval 2
Pre-Op BMI 52.3
Comorbidities Sleep apnea, hypertension
Comments I constantly stayed in contact with my Insurance Co. I believe they respond greater to persistence. I recomend you get diagnoised Morbid Obese by Insurance Co. and your PCP as soon as you can before applying for surgery. It seemed to go quicker.
Source Pamela M
Insurer Policy Aetna (HMO)
Insurer StatusApproved after first letter (03/31/01)
Surgery Type Laparoscopic RNY - distal
Weeks to approval 1
Comorbidities High Blood Pressure, Arthritis
Policy Don't know
Comments I sent my primary care doctors referral along with a personal letter. My letter included the medical problems I was experiencing because of obesity. Within 2 days I was approved. I ran in to one problem however, the hospital the surgeon used was out of network. I requested non-par approval and received it quickly. Aetna's approval nurse was obnoxious. I needed to provide updated information and she wouldn't take my call. I called 4 times over a 2 week period. Each time, my call was screened and I was put through to her voice mail. Finally, my PCP called and asked if I was trying to get through to the nurse. I told her of my attempts and she said that the nurse refused to speak to patients. Excuse me....why wasn't I told that on the first call. Anyway...it's ended well, but customer service at Aetna is in need of improvement.
Source Michelle C
Insurer Policy Aetna (HMO)
Insurer StatusApproved after first letter (11/04/02)
Surgery Type Laparoscopic RNY - distal
MD-supervised programs 4 (57 weeks)
Source Steffney W
Insurer Policy Aetna (PPO)
Insurer StatusApproved after first letter (09/02/01)
Surgery Type Open RNY
Weeks to approval 3
Pre-Op BMI 63.1
Comorbidities depression
Policy Must be medically necessary
Comments Overall they were good. They stalled some it seemed nobody knew for 3 weeks where the information package from my docter was, once they "found" it I was approved in 72 hours. I know the respond to persistence. If you meet the criteria, they have to accept you. My Policy has a written policy on bariatric surgery.
Source Bonni L
Insurer Policy Aetna
Insurer StatusDenied after 2nd appeal letter (09/01/02)
MD-supervised programs 2 (62 weeks)
Source Nancy M
Insurer Policy Aetna (Cooper Industries. Inc)
Insurer StatusApproved after first letter (09/09/01)
MD-supervised programs 2 (40 weeks)
Source Carole S
Insurer Policy Aetna (PPO)
Insurer StatusApproved after first letter (4/06/01)
Surgery Type Laparoscopic RNY
Weeks to approval 4
Pre-Op BMI 41.3
MD-supervised programs 2 (12 weeks)
Comorbidities GERD, Incontinence, Arthritis
Policy Must be medically necessary
Comments I thought dealing with Aetna was fine. I got the info from my original surgeon (and mailed it to them personally. After one week I called and they said that I had mailed it to the wrong address. It was the one THEY had given me... "Here we go", I thought but it was actually fine. I faxed it in that day and was approved 3 weeks later. I do feel that they responded to persistence because after 1 weeks I called almost every day. I would recommend that you start off prepared with all of your info. Initially, make sure you follow up with the date that they received your info. Keep track of dates and time you called and names of the reps you speak to. When you are certain they have received your info, I would wait two weeks and call each day if you are obsessive like me or call every few days.
Source Lisa S
Insurer Policy Aetna (EPO)
Insurer StatusFirst letter sent - still waiting (02/22/02)
MD-supervised programs 2 (30 weeks)
Source Sharon E
Insurer Policy Aetna (US Healthcare)
Insurer StatusApproved after first letter (04/24/02)
Surgery Type Open VBG
Weeks to approval 3
Policy Don't know
Comments I didnt personally deal with Aetna. Everything was handled through the doctors office. I did have to call to ask them one question, and they were very helpful. My paperwork was submitted, and I got my approval within 2 1/2 weeks.
Source Keisha G
Insurer Policy Aetna
Insurer StatusApproved after first letter (05/07/02)
Surgery Type Open RNY
Weeks to approval 3
Pre-Op BMI 47.3
MD-supervised programs 2 (8 weeks)
Comorbidities Asthma, reflux, diabetes, menstrual irregularities, joint problems, back pain, shortness of breath
Policy Must be medically necessary
Comments Aetna overall was a good insurance company for me. I had no problem getting approved. I did have to call very frequently to "get the ball rolling." I think being persistent pays off. I would still recommend Aetna to others.
Source Laura W
Insurer Policy Aetna (Aetna Managed Choice)
Insurer StatusApproved after first letter (09/05/02)
Surgery Type Laparoscopic RNY - proximal
Weeks to approval 4
Pre-Op BMI 65.6
Policy Must be medically necessary
Comments I know that Aetna has an approval clause for the Roux-En-Y bypass and will approve it based on two criteria. 1) bmi greater than 40 and 2) been on doctor supervised diet for at least 6 mos within the last 2 years. With a BMI of 65.1, I definitely pass no. 1, but I may have an issue with no. 2. I will let you all know as soon as I find out. Well, After 4 weeks of calling daily, Aetna finally came through with my approval. I haven't got the paperwork in the mail yet, but I have talked to Aetna and they have approved on my information.
Source Mark C
Insurer Policy Aetna
Insurer StatusApproved after first letter (June 5th 2003)
Surgery Type Laparoscopic RNY - proximal
Weeks to approval 6
Pre-Op BMI 47.5
Comorbidities sleep apnea,thyroid disease,hyperten.arthritis, fybromyalgia, high fasting insulin level, high chole
Policy Must be medically necessary
Comments My insurance co was great. The bariatric surgeons offic did not send enough info. I needed past two years medical hist from family doctor. But insur co notified everyone by phone as well as in writing. Some wires got crossed with where to mail the info which caused about a two week delay. Aetna was very proactive and kept me informed. It is very important that you have a documented medical and psychological history. You have to prove that you have done everything humanly possible to loose weight. I had done all my homework and there were really no probs with insur.
Source Janet B
Insurer Policy Aetna (PPO)
Insurer StatusApproved after first letter (04/08/03)
Surgery Type Laparoscopic RNY - proximal
Weeks to approval 1
Comorbidities arthritis,hypertension,sleep apnea
Policy Must be medically necessary
Comments I am very impressed! My doctor's office submitted my file for approval on 4/5/03, and I was approved on 4/8/03! I cannot believe it! The key is to have everything that they want for documentation!
Source Lisa S
Insurer Policy Aetna
Insurer StatusApproved after first letter (08/30/02)
Surgery Type Laparoscopic RNY
Pre-Op BMI 53.1
Policy Don't know
Source Jennifer P
Insurer Policy Aetna (Managed Care)
Insurer StatusApproved after first letter (09/18/02)
Surgery Type Laparoscopic RNY
Pre-Op BMI 47.6
Comorbidities sleep apnea, depression(low self-esteem) hypertension, cholestrol
Policy Must be medically necessary
Comments It was easier than I thought. Two years ago I tried with Cigna but was rejected. I had all my ducks in a row including a letter from my PCP saying I needed the surgery. I would get AS MUCH DOCUMENTATION to send in your packet the first time you do your request.
Source Don H
Insurer Policy Aetna (managed choice pos)
Insurer StatusApproved after first letter (10/23/02)
Surgery Type Open RNY
Weeks to approval 4
Pre-Op BMI 65.2
Comorbidities diabieties,joint pain
Policy Must be medically necessary
Comments I feel aetna is the best i could have gone with,.. I purpously changed to them in order to have this covered 100% I feel very lucky to have such great health care. They always have answered all of the questions I have asked them..
Source Erinn M
Insurer Policy Aetna (HMO)
Insurer Status (11/22/02)
MD-supervised programs 1 (6 weeks)
Source Jessica K
Insurer Policy Aetna (pos)
Insurer StatusApproved after appeal letter (6/25/03)
Surgery Type Laparoscopic RNY
Weeks to approval 12
Pre-Op BMI 50.1
Comorbidities gerd, urinary incontinence, shortness of breath, lower back pain
Policy Must be medically necessary
Comments You have to have 6 months worth of a physician supervised diet. I did not have that at first and was denied. Luckily I have a wonderful pcp that helped me get approved. I did have to wait the 6 months and see my pcp each month to weigh.
Source Michelle S
Insurer Policy Aetna (POS)
Insurer StatusFirst letter sent - still waiting (12/27/02)
MD-supervised programs 1 (6 weeks)
Source Tarsha S
Insurer Policy Aetna
Insurer StatusApproved after first letter (08/10/2003)
Surgery Type Laparoscopic RNY
Pre-Op BMI 51.7
Source Amanda L
Insurer Policy Aetna (Managed Choice)
Insurer StatusApproved after appeal letter (12/15/03)
Surgery Type Laparoscopic RNY
Weeks to approval 4
Pre-Op BMI 60.8
Comorbidities Sleep apnea, depression
Policy Must be medically necessary
Comments I really had no contact with them. Helen at Dr. Miles's office dealth with them.
Source Anita D
Insurer Policy Aetna
Insurer StatusFirst letter sent - still waiting (03/05/03)
Source Ellen P
Insurer Policy Aetna (ppo)
Insurer StatusApproved after first letter (03/06/03)
MD-supervised programs 1 (52 weeks)
Source Robert M

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