Insurance - ThinnerTimes

seen&heardall · 12-18-2006, 09:27 AM

NOTE: Moved from "Feedback and Suggestions"

I am not sure if this was brought up before (I searched to no avail). But . . . I was wondering if it would be benefical to the Newbees searching for info to have a thread for the different types of insurances to use for WLS.

Some of the info provide could be as follows: (not factual info, testing only)

Type of insurance used: BCBS of CA PPO
How long did it take for approval: 6 mons.
Out of pocket expense? $1500
Special Requirements: 6 month supervised diet
Unusual Circumstances: Denied once. Must follow-up continuously.
How would you rate/would you recommend this insurance carrier: 5/NO.

Cinerbelle · 12-18-2006, 01:53 PM

Type of insurance used: Aetna HMO
How long did it take for approval: 2 Days
Out of pocket expense? Reg. copays for all testing appointments
Special Requirements: 6 month supervised diet
Unusual Circumstances: None
How would you rate/would you recommend this insurance carrier: YES!!!

LoriAnn925 · 12-18-2006, 02:06 PM

Type of Insurance: Cigna Open Access Plus
How Long did it take for approval?: Denied first time - took 30 days (needed supervised 6 mo diet) Second submit: approved in 2 days
Out of Pocket expenses: Approx: $1200
Special Requirements: 6 mo physician supervised diet, documentation on monthly visits (no getting around it)
Unusual circumstances: none
How would you rate/would you recommend? Yes, if you meet all their requirements (spelled out on website).

Duckie · 12-18-2006, 03:05 PM

I used BCBS of MA. My only out of pocket expense were copays for visits. $0 for surgery. I had no unusual circumstances. No supervised diet necessary. BMI and/or comorbidity requirements and psych consults necessary. I was approved within 2 weeks.

Rachel · 12-18-2006, 05:22 PM

Type of insurance used: Kaiser Permanente, Northern California

How long did it take for approval: About 1 month

Out of pocket expense: Regular co-pays for tests and Hospital stay

Special Requirements: Lose 10% of your weight and attend several classes, along with Phsyc Evaluation and Nutrition Evaluation. If BMI is less than 50, there must be co-morbidities to qualify.

Unusual Circumstances: None

How would you rate/would you recommend this insurance carrier: Yes

Here is link to the Richmond Medical Facility Informational Binder . Everyone gets a binder when they attend the orientation.
http://www.permanente.net/homepage/kaiser/pdf/39806.pdf

monkeygrly · 12-18-2006, 06:56 PM

Type of insurance used: Aetna HMO
How long did it take for approval: 2 weeks
Out of pocket expense? Reg. copays for all testing appointments
Special Requirements: 6 month supervised diet but I wasn't required by my medical group to another diet in addition to what had all ready been documented in my medical records
Unusual Circumstances: None
How would you rate/would you recommend this insurance carrier: YES!!!

butterfly2b · 12-18-2006, 07:12 PM

Type of Insurance: Helth Net POS
How long to get approval: 3 weeks
Out of Pocket expences: Limitted to $10.00 office copays
Special circumstances: Per insurance contract, must have 6 months, documented medically supervised diet.
How would you rate / reccomend insurance carrier? 8/10 / yes
Experience: I was denied for my initial consult with barriatric surgeon. My PMD's office and I wrote a letter citing CDC requiremnts & my co-morbidities.
After letter, approved for consult in 4 days.

Martha · 12-18-2006, 07:38 PM

Type of insurance used: Anthem BCBS
How long did it take for approval: 6 days after insurance submittal
Out of pocket expense? Regular Doctor Co-pays and Deductible
Special Requirements: BMI over 35 with co-morbidities or over 40 with none, Diet history, Pysch Eval and Nutrition Eval
Unusual Circumstances: None.
How would you rate/would you recommend this insurance carrier: Yes

LisaM · 12-19-2006, 07:18 AM

Type of insurance used: Tricare Prime
How long did it take for approval: 2 days
Out of pocket expense? Regular doctor, hospital and testing co-pays, only the dietician/nutritionist was out of pocket - about $275 all told
Special Requirements: 100 pounds overweight with one co-morbidity, or 200 percent of ideal weight with no co-morbidity necessary
Unusual Circumstances: They do not cover lapband or BPD.
How would you rate/would you recommend this insurance carrier: Unfortunately, they're only available to military/retired military and their dependents, but if you fall in that category, they're great.

kimberasti · 12-20-2006, 07:11 PM

That really helps a lot!!! Thank you for taking the time to post so much information!!!!

Kim