| Blue Cross Blue Shield |
|---|
| Insurer Policy |
Blue Cross Blue Shield (PPO) |
| Insurer Status | Approved after first letter (03/28/05) |
| Surgery Type |
Open RNY |
| Source |
Nylla W |
| Access |
|---|
| Insurer Policy |
Access |
| Insurer Status | Approved after first letter (04/10/05) |
| Source |
Davina C |
| Insurer Policy |
Access |
| Insurer Status | Approved after first letter (06/25/06) |
| Surgery Type |
Laparoscopic RNY |
| Comorbidities |
GERD, Hypertension, Depression, PSOD |
| Policy |
Don't know |
| Source |
Sherri B |
| Insurer Policy |
Access |
| Insurer Status | Approved after first letter (May3,2007) |
| Surgery Type |
Laparoscopic Lap Band |
| Weeks to approval |
1 |
| MD-supervised programs |
3 (13 weeks) |
| Comorbidities |
sleep apnea,arthritis |
| Policy |
Don't know |
| Comments |
My Dr sent in the letter on April 27 and I got my Approval on May3. It was beyond easy to be approved. I did 6 months with my Pcp they only require 3 months! |
| Source |
Crystal W |
| Insurer Policy |
ACCESS |
| Insurer Status | Approved after first letter |
| Comorbidities |
Arthritis, Hypercholesterolemia |
| Source |
Marissa W |
| Access Medical |
|---|
| Insurer Policy |
Access Medical |
| Insurer Status | First letter sent - still waiting (07/09/01) |
| MD-supervised programs |
2 (36 weeks) |
| Source |
WendyJo M |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after appeal letter (04/21/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
71.0 |
| Comorbidities |
DIAGNOSED MORBIDLY OBESE |
| Policy |
Must be medically necessary |
| Source |
Robyn C |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (6/23/2001) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
42.7 |
| Source |
Cheryl D |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (11/08/01) |
| MD-supervised programs |
4 (64 weeks) |
| Source |
Glenda M |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (08/24/02) |
| Surgery Type |
Open Duodenal Switch |
| Weeks to approval |
2 |
| Pre-Op BMI |
58.6 |
| MD-supervised programs |
2 (14 weeks) |
| Comorbidities |
enlarged heart & heart palpitations, sleep apnea, arthritis, depression & anxiety, prone to pnemonia |
| Policy |
Must be medically necessary |
| Comments |
My doctor's medical secretary said they are very slow to return calls and they require many kinds of proof that this surgery is medically necessary. I get the impression that they require more than other insurance companies require. A friend of mine is also going to get the same surgery done from the same doctor as I am and I started the process 2 months before she did. She has different insurance than mine. She was approved before I was and she didn't have to provide as much paper work or reports from previous physicians as I did. I also had to undergo more testing than she did.
I think once my insurance saw that this surgery is medically necessary, they didn't stall at all. Up until that point there was a lot of redtape that held things up. I also heard complaints that this company is slow at paying the surgeons and as a result some surgeons are hesident about taking patients that have medical assistance.
I don't know how well they responded to persistence, I didn't have much personal contact with them. The few times I did call to talk to them they would not tell me anything. They said they needed to talk to my surgeon or his staff directly.
My advice to anyone needing to get this surgery and is on MA, is to stay in weekly or biweekly contact with your surgeon's staff. Make sure they know you are still waiting and not only wanting the surgery but also needing it...I think the more persistant you are with the medical staff the more persistant they will be with the insurance company. |
| Source |
Lorrie D |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after appeal letter (01/24/02) |
| Surgery Type |
Other |
| Weeks to approval |
12 |
| Policy |
Don't know |
| Source |
Marcy S |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (02/05/02) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Pre-Op BMI |
44.3 |
| MD-supervised programs |
1 0 |
| Policy |
Must be medically necessary |
| Comments |
I did not deal with the insurance company at all. They needed additional proof for the last year weight loss attempts. I was approved in 3 working days. |
| Source |
Christina H |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (08/28/02) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
3 |
| MD-supervised programs |
1 (12 weeks) |
| Comorbidities |
indigestion |
| Policy |
Must be medically necessary |
| Comments |
I think that they give you a little bit of a run around. I haven't seen my doctor for my initial cosultation yet but they said that it would be covered. Then I would have to have a medical reason for the surgey and being morbidly obese is not enough. You have to keep on them, keep calling. |
| Source |
Mindy G |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (02/16/02) |
| Source |
Tina P |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (04/15/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
75.1 |
| MD-supervised programs |
3 (142 weeks) |
| Comorbidities |
hyenial hernia, edema , acid reflux, asthma, joint pain and gallstones |
| Policy |
Must be medically necessary |
| Comments |
i did not have to deal with them my doctors office took care of everything was approved before all there required test were done |
| Source |
Roberta R |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (04/18/02) |
| MD-supervised programs |
3 (12 weeks) |
| Comments |
If you are on PA Access make sure you include documented supervised dieting for at least 6 months or you will be denied. |
| Source |
Christy M |
| Insurer Policy |
Access Medical |
| Insurer Status | (07/01/02) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
45.3 |
| Source |
Kathleen S |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (9/02/02) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
50.2 |
| MD-supervised programs |
1 (52 weeks) |
| Policy |
Don't know |
| Comments |
I didn't have to deal with them. Dr. Hamads office took care of everything. It took less than a week for approval. |
| Source |
Sandy W |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (11/22/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
50.8 |
| Policy |
Don't know |
| Comments |
I think that the insurance company put me thru pretty fast. I don't recommend using it because it was medical assistance but it is there if you need it. I know that some of the other medical assistance programs are horrible and won't help you out. You have to nag them. |
| Source |
Cindy H |
| Insurer Policy |
Access Medical |
| Insurer Status | First letter sent - still waiting (11/27/02) |
| Surgery Type |
RNY |
| Pre-Op BMI |
47.3 |
| MD-supervised programs |
1 (12 weeks) |
| Policy |
Don't know |
| Comments |
They were nice, but the wait! It was a very great place, friendly people, but confusing to get around in the hospital. But it still was a very great staff. |
| Source |
Adam H |
| Insurer Policy |
Access Medical |
| Insurer Status | First letter sent - still waiting (01/09/03) |
| MD-supervised programs |
1 (6 weeks) |
| Source |
Linda W |
| Insurer Policy |
Access Medical (ppo) |
| Insurer Status | Approved after first letter (01/15/03) |
| Surgery Type |
Laparoscopic RNY |
| Policy |
Must be medically necessary |
| Source |
Jo W |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (03/21/03) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
45.3 |
| Policy |
Don't know |
| Source |
Staci J |
| Insurer Policy |
Access Medical (med +) |
| Insurer Status | Approved after first letter (06/11/03) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
43.3 |
| Policy |
Must be medically necessary |
| Comments |
i didn't have to deal with the insurance company at all. The Dr. Office took care of everything. It only took 1 day to approve. |
| Source |
Tonia B |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (1/25/04) |
| Weeks to approval |
2 |
| Pre-Op BMI |
41.4 |
| MD-supervised programs |
3 (88 weeks) |
| Comorbidities |
arthritis in both knees,knees also in need of knee replacements,2 buldging in lower back near L4,L5, |
| Comments |
I didn't have to deal with them my doctors office did it all for me from the time i had last visit with Dr.Stills to my surgeon consult (less then a month)I was approved |
| Source |
Mary H |
| Insurer Policy |
Access Medical (enhanced access hmo) |
| Insurer Status | Approved after first letter (12/26/03) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
56.9 |
| Comments |
I had no problem. My pcp sent a letter with my diet history and complications of my obesity and was approved within 3 days. I can't wait to be scheduled for this surgery. I'm sooooo incredibly sick of being so fat! |
| Source |
Finallylosingweight B |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (12/19/03) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
53.9 |
| Comorbidities |
PCOS, Hyperinsulinemia, Osteoarthritis, GERD, Depression, Bipolar Disorder, Morbid Obesity |
| Comments |
Access has seemed to be a Godsend through all of this. They've been wonderful in getting my medications in the past...and ever since I started this whole journey, they were incredible. They not only approved me this time, but also approved me once prior to this with a different surgeon. I ended up not having the surgery then because I wanted to pursue lap instead of open. |
| Source |
Katrisha B |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (01/09/04) |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
44.3 |
| Source |
Gayle A |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (05/19/04) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
46.5 |
| Source |
Dana W |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (07/21/04) |
| Surgery Type |
RNY |
| Pre-Op BMI |
40.2 |
| MD-supervised programs |
2 (8 weeks) |
| Source |
Alba L |
| Insurer Policy |
Access Medical |
| Insurer Status | First letter sent - still waiting (08/26/04) |
| Policy |
Don't know |
| Source |
Rachel G |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (09/27/04) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
41.3 |
| Policy |
Must be medically necessary |
| Source |
Tammy S |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (10/16/04) |
| Weeks to approval |
2 |
| Comorbidities |
High blood pressure, diabeties, poly-cystic ovaries, arthritis |
| Policy |
Must be medically necessary |
| Comments |
The only problem I had with this part was that the doctor,s office forgot to send for approval because I had changed insurance months before so someone seen insurance approved from that one and noone sent in for the other. With any doctor,d office I recommend that you check to see if your insurance has granted approval. |
| Source |
Rosemary B |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter (11/29/04) |
| Pre-Op BMI |
44.6 |
| Source |
Rebecca G |
| Insurer Policy |
Access Medical |
| Insurer Status | Approved after first letter |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
41.3 |
| Policy |
Don't know |
| Source |
Andrea U |
| Access or Access Plus |
|---|
| Insurer Policy |
Access or Access Plus (Welfare) |
| Insurer Status | Approved after first letter |
| Surgery Type |
Laparoscopic Vertical Sleeve Gastrectomy |
| Pre-Op BMI |
69.3 |
| Source |
Carol B |
| Access/Medicade |
|---|
| Insurer Policy |
Access/Medicade |
| Insurer Status | Approved after first letter |
| Comorbidities |
GERD, Arthritis, Hypertension, Chronic skin conditions, Depression, Hypercholesterolemia, Shortness |
| Source |
Margaret R |
| Access/Medical Assistance |
|---|
| Insurer Policy |
Access/Medical Assistance |
| Insurer Status | Approved after first letter (01/27/06) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
48.6 |
| Comorbidities |
Arthritis, Diabetes, GERD, Hypercholesterolemia, Shortness of breath, Sleep apnea, pseudotumor cereb |
| Policy |
Must be medically necessary |
| Comments |
I never dealt with them at all. Dr. Raftopoulos's secretary(nurse Babs) did it all she is wonderful! They were great with time also..Very fast and effective. The Insurance company also was very fast, they really surprised me...I thought they would take a long time. |
| Source |
Jennifer D |
| acess |
|---|
| Insurer Policy |
acess |
| Insurer Status | Approved after first letter (01/10/06) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
44.2 |
| MD-supervised programs |
3 (48 weeks) |
| Comorbidities |
Depression, GERD, Hypertension, Shortness of breath, Stress incontinence, Venous stasis disease |
| Policy |
Don't know |
| Source |
Krista D |
| Insurer Policy |
acess |
| Insurer Status | Approved after legal action taken (08/09/06) |
| Comorbidities |
Arthritis, Hypertension, Chronic skin conditions, Hypercholesterolemia, Stress incontinence, Venous |
| Source |
Jackie B |
| Acordia |
|---|
| Insurer Policy |
Acordia (ppo) |
| Insurer Status | Approved after appeal letter (02/12/05) |
| Surgery Type |
Open RNY |
| Weeks to approval |
8 |
| MD-supervised programs |
1 (28 weeks) |
| Comorbidities |
Diabetes,HTN,DJD,GERD |
| Policy |
Must be medically necessary |
| Comments |
Initially I began dealing with the Insurance in June,2004. It is an Employer paid plan. My plan has a pre-certification program and a 3rd party administrator. After all this time I was approved February 16th. I am recommending anyone with an employer paid plan to 1. Join this website for valuable help. It's members helped educate me 2. Copy their policy page on bariatric surgery and know all their requirements in advance. 3. Make sure you know who is the claims administrator for your health Plan. They work for your employer determining and processing what benefits to pay and what is not covered. 4.Make sure the Surgeons office has the correct information of your plan. Do not just give your insurance card to The surgeon's office and forget it.(with Employer paid plans) I was adhearing to guidelines not on my plan. I do know the Insurance stalled. But after the documentation was correctly re- submitted I was approved. |
| Source |
Robin P |
| Insurer Policy |
Acordia (ppo) |
| Insurer Status | Approved after appeal letter (12/02/05) |
| Surgery Type |
Open Duodenal Switch |
| Comorbidities |
Sleep apnea |
| Source |
William G |
| Advantage |
|---|
| Insurer Policy |
Advantage (ppo) |
| Insurer Status | Approved after first letter (08/25/00) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
51.7 |
| MD-supervised programs |
3 (12 weeks) |
| Comments |
my insurance gave approval within 3 wks wich i understand is the norm.......i've had no problems thus far with any type of claim from my carrier. |
| Source |
Christeen M |
| Advantra |
|---|
| Insurer Policy |
Advantra (Medicare HMO) |
| Insurer Status | Approved after first letter (10/30/03) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
51.3 |
| Comorbidities |
morbid obesity |
| Policy |
Must be medically necessary |
| Comments |
After going through their pre-op requirements, my surgery was approved 3 days after all of the information was sent to the insurance company. |
| Source |
Lisa G |
| Insurer Policy |
Advantra |
| Insurer Status | Approved after first letter (05/03/04) |
| Weeks to approval |
2 |
| Comorbidities |
Arthritis, sleep apnea, DJD, hypertention, 2 back surgeries |
| Policy |
Don't know |
| Comments |
Doctor's office had a list of requirements for approval and made sure they had all been met before submitting for approval.
I had heard horror stories but had no problems at all. Approval was done in a very timely manner.
Make sure you have fulfilled and documented all of their requirements. They do supply the surgeon's office a list of what they need to consider a request. |
| Source |
Pat L |
| Aetna |
|---|
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (6/21/99) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
4 |
| Pre-Op BMI |
45.5 |
| Comorbidities |
NIDDM, GERD, borderline HTN, arthritic pain in joints, back pain |
| Policy |
Must be medically necessary |
| Comments |
I didn't have any problem at all dealing with my insurance company.....of course, i've heard that Dr. Colberg writes a very good "Letter of Medical Necessity". |
| Source |
Diane R |
| Insurer Policy |
Aetna (QPOS) |
| Insurer Status | (12-16-99) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
48.4 |
| Comorbidities |
I am "basically" healthy (is that an oxymoron?) |
| Policy |
Must be medically necessary |
| Comments |
I dealt with no one, there was no wait. I wish it could be this easy for everyone! |
| Source |
Erica S |
| Insurer Policy |
Aetna (same) |
| Insurer Status | Approved |
| Surgery Type |
Open VBG |
| Pre-Op BMI |
55.6 |
| Comments |
Absolutely no problems with getting approval |
| Source |
Mona S |
| Insurer Policy |
Aetna (US Healthcare) |
| Insurer Status | Approved (4-98) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
73.7 |
| Comorbidities |
Sleep Apnea, amenorreah, hypertension |
| Policy |
Don't know |
| Source |
Sherry F |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter |
| Surgery Type |
Open VBG |
| Weeks to approval |
1 |
| Pre-Op BMI |
53.3 |
| Comorbidities |
BMI = 55.1; Sleep apnea |
| Comments |
Dr. Weaver's office did all the work. I just showed up. |
| Source |
Patti W |
