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What is the 'best' insurance that covers gastric bypass?

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#1 Vocley



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Posted 05 March 2009 - 01:43 AM

I am currently on Aetna. They told me that my current policy does not cover the gastric bypass surgery, even if I have all criteria met. I have been doing some research and have found all sorts of insurance companies but I do not know which one to apply.

From your experience in your personal life and here on this forum, which insurance company is best for gastric bypass? Is this something I should talk to with my doctor?
In the process of a life changing surgery...

#2 ladybugnessa



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Posted 05 March 2009 - 03:07 AM

what are your options for insurance?

because if someone has insurance they recommend but you have no option of getting it that's going to be pretty frustrating.

and could you define BEST. please.

is it easiest to get approved?
is it the one that covers the most payment?
HW: 286 5/1/06 CW 245 GW 175
Seminar 2/18/09
first consult 3/9/09
next step pending

#3 Native2u



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Posted 05 March 2009 - 04:25 AM

I would have to say.....call your current doctor and ask to speak with their "insurance" person (the person who files all of the doctors claims with the insurance companies). Ask the insurance person about the insurance companies. Save yourself a co-pay to the doctors office.

Maybe also call a couple of different insurance companies and ask them about their services and if they cover WL surgery. Get each of them to "mail" you copies of what they offer. Then compare them and also ask us about them. We'll tell ya if we've had trouble or not.

#4 GTR-Mark


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Posted 14 March 2009 - 06:27 AM

I was told that Blue Cross, Blue Shield PPO's are generally good for offering this benefit. That is what I have and the process to get approved was very smooth.


#5 njnicole10



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Posted 14 March 2009 - 06:29 AM

i was told horizon blue cross blue shield was one of the best. i had a hmo but i know others that have had ppo, or epos and gotten approved.
good luck!
surgery date 12-29-08
90 pounds gone forever in just over 4 months!!

#6 moniram8


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Posted 14 March 2009 - 06:29 AM

I myself had my surgery using Aetna QPOS. My surgeon and hospital were
both in-network providers. My surgery was covered 100% with NO deductible. It literally didnt cost me a dime.

start pre-op diet...254
GP on 5/1/08.......240
as of 7/14/08.......198.....ONEDERLAND!!!
as of 11/21/08......157....My BMI is NORMAL!!!!
as of 12/4/08.......154.....At goal in only 7 months!!!
as of 2/20/09.......148
ONE YEAR POST OP 5/1/09...holding steady at 148
as of 5/10/09.......145....the scale MOVED AGAIN!!


#7 AlphaChiTheta



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Posted 24 March 2009 - 10:16 PM

I have Aetna PPO and it was smooth sailing for me. Approved instantly. I would check to see if you could get a different Aetna plan.

Highest/Day of Surgery: 306 Current: 198 Dr's Goal: 180 My Goal: 150 Surgery April 1, 2009 :D


#8 Cabbie


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Posted 25 March 2009 - 07:02 AM

I have an HMO with Amerihealth. Unlike many on these boards, I didn't have to entertain some insurance company bureaucrat by jumping through hoops for six months before my insurance company would agree to pay for my gastric bypass. My surgery was approved the same day that my surgeon's office contacted my insurance company. My only out-of-pocket expense was the $500 co-pay that is required whenever I am admitted into the hospital as an in-patient. That $500 co-pay, incidentally, is a drop in the bucket when you consider that final bill for my surgery came to just over $57,000. All things considered, I couldn't be more satisfied with my health insurance company.

#9 rito1



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Posted 28 March 2009 - 12:57 PM

I myself had my surgery using Aetna QPOS. My surgeon and hospital were
both in-network providers. My surgery was covered 100% with NO deductible. It literally didnt cost me a dime.

I have Aetna also and I have a $1500 deductible.

#10 Rebirth_103008


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Posted 28 March 2009 - 04:07 PM

I have an Anthem EPO plan. The only cost to me was a $250 hospital co-pay. No red tape or hoops to jump thru and no 6-month supervised diet. Just needed to meet the BMI requirements and submit my medical records from the last 3-5 years.
Highest/Before Liquid Diet/Before Surgery/Current
Roux-en-Y Surgery Date: 10/30/08

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#11 CrazyElvis



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Posted 27 April 2009 - 10:16 AM

I have an offshoot of UnitedHealth Care called Definity Health.....thru Target.

All that was needed for submission was my height, weight and BMI....then I was approved within about two weeks.

There was no supervised diet or anything........I started the whole process in early Sept. 2008 and my surgery was Oct. 27, 2008.

No glitches or problems.
Type: Lap RNY
Seminar: 9/16/08 Done
1st Dr. Appt. : 9/17/08 Done
Nutrionist : 9/18/08 Done
Psych Appt. : Waived (Doc said I wasn't CrAzY:eek:)
Inurance Submitted : 9/25/08
Insurance Approved : 10/09/08
Surgery Date: 10/27/08

#12 Celestine



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Posted 07 May 2009 - 09:07 PM

I have Aetna, hoping there isn't any problems with approval. I go tomorrow for my last PCP visit. I was assigned a case manager (nurse) by Aetna. I did everything required by Aetna.

#13 deputymauldin


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Posted 07 May 2009 - 10:07 PM

I think it depends on what plans your job offers. Does your job cover wls on any plan? I have blue shield of ca POS and I only had to follow the hospitals plan. My approval took about 4 days.
Finally submitted for approval 4/28/09
Approved 5/5/09
Final Labs 6/30
Surgery date 7/7/09

#14 Guest_Tess_*

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Posted 08 May 2009 - 09:53 AM

Id say run around here and check out all the "APPROVED" Threads and asked them what they have:D