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Thread: Insurance

  1. #1
    Gastric Sleeve Member
    I have had a gastric sleeve.
    Name
    Jessica Holliday
    Surgery date
    02/19/2013
    Surgeon
    Dr. Sanborn
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    Default Insurance

    Hello everyone!! I was wanting to get some input on how hard it is to have insurance approve the surgery. Thanks!



  2. Gastric Sleeve Surgery With Weight Loss Agents
  3. #2
    Gastric Sleeve Member
    I have had a gastric sleeve.
    Name
    Jenn
    Surgery date
    01/14/2013
    Surgeon
    Dr Ravindra Malipur
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    Dec 2012
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    Alabama
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    Default Re: Insurance

    The general consensus is that it depends on your insurance. Most have some hoops you have to jump through but if you complete them and meet their requirements most times it will get through. Some people have awful insurance and never get it sorted out.



  4. #3
    Gastric Sleeve Member
    I have had a gastric sleeve.
    Name
    Jessica Holliday
    Surgery date
    02/19/2013
    Surgeon
    Dr. Sanborn
    Join Date
    Jan 2013
    Last Activity
    02-10-2013 09:17 AM
    Location
    Fort Oglethorpe, GA
    Posts
    2
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    Said "Welcome to Gastric Sleeve" 3 Times
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    Default Re: Insurance

    I have Blue Cross Blue Shield but its fairly new insurance, I'm just worried they are going to try to say being overweight is a pre-existing condition. I'm excited to get the process started just worried about what all its going to take.



  5. #4
    Gastric Sleeve Member
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    Default Re: Insurance

    Insurance is a major concern for those of us who have been lucky enough to have our surgery covered by insurance. By chosing a good bariatric team, they will be your best ally and advocate to get your surgery covered. I would suggest you do some research on your own with your insurance company. Take a look at the policy or give them a call. Better to know up front than later. Remember also that it is not just your insurance provider that determines your benefits, but the plan that your carrier follows is set up with your employer and the carrier. So all Blue Cross Blue Shield patients, my not have the same requirements.

    I have Aetna and had a very easy time. My bariatric team had a lot to do with that. My requirements to qualify were basically a bmi of 40 or above or 35 with 2 comodalities such as high blood pressure, high cholesterol, diabeties, etc.

    Good luck.

  6. #5
    Banned
    I have had a gastric sleeve.
    Name
    Christy
    Surgery date
    09/08/2011
    Surgeon
    Dr. Mario Almanza
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    Jul 2011
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    Default Re: Insurance

    New federal laws prohibit "Pre existing condition" clauses. I THINK that has started...it may start in 2014...hopefully not!

  7. Gastric Sleeve Surgery With Weight Loss Agents
  8. #6
    Gastric Sleeve Member
    I have had a gastric sleeve.
    Name
    Laura
    Surgery date
    12/27/2012
    Surgeon
    Dr. LaMasters
    Join Date
    Dec 2012
    Last Activity
    05-08-2013 03:32 PM
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    Granger, Iowa
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    Default Re: Insurance

    The big thing to remember with insurance, especially if you have it through your employer, is that there can be minor tweaks even with the same product from the same company. This is more prevalent with employer provided insurance as employers pick and choose options to keep costs affordable. I am thinking the pre-existing conditions takes affect on 1-1-2014. Lots of changes will roll out then. I am a business analyst at a health insurance company and have learned lots the past 14 months I have been employed there. Your best bet is to directly call your insurance and find out the requirements. It is important to find out if they have a 6 month dr supervised diet piece of the process and exactly what that entails as I have heard a wide range of descriptions, even with my own insurance company.


    Highest Weight - 291 12/18/2012 (Pre-op visit)
    Weight at Surgery - 285 12/27/2012
    Date I reach 245 (weight when lap band was removed 4/2012) -
    Date I reach 225 (lowest weight achieved with lap band) -
    Date I reach onederland -

  9. #7
    Gastric Sleeve Member
    I have had a gastric sleeve.
    Name
    Anne
    Surgery date
    12/26/2012
    Surgeon
    Dr. Raul Rosenthal
    Join Date
    Dec 2012
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    02-19-2020 03:58 PM
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    Miami, FL
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    Default Re: Insurance

    I had BCBS of GA with my previous employer and they did not cover it but my employer also bought whatever the bare minimum they had to. Call the 800 number and ask it will probably take them a week or two to call back with an answer. There should also be a complete booklet of what is covered online that you can read through as well. I think it's called a certificate book if I remember correctly.



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