|
|
Benefits Approval
There are many ways patients cover the cost of their surgery.
Some have insurance benefits that cover weight loss surgery, while
others pay out of pocket. There may also be other resources available
to you such as government or federal programs or agencies that may
be able to assist you. Read some of our patient's comments about how
they obtained their surgery.
We participate with Devon Healthcare, Highmark Blue Shield,
Valley Preferred, and we're negotiating with Horizon, Aetna, and Capital
Blue Cross.
PLEASE NOTE: These
are comments posted by the public. We do not endorse or recommend
any of the companies or agencies below.
This page remains under development. Please pardon our progress,
and check back often for updates.
Aetna - EPO (PA) - 04/26/04
(Kelly V.)
Aetna - ppo (NJ) - 06/08/04
I did not deal with Aetna much, my request was submited on tuesday and approved on thursday. i called today to find out if there was a copay for being admitted into the hospital and was told all i would have to pay for is phone and tv. I reccomend aetna to anyone lookin to get wls. they took care of things in a timely manner. you MUST have six months of documented diets though and i believe family history of medical problems helps. (Stephanie R.)
Aetna - QPOS (NJ) - 4/14/05
Well first off I have to warn all who have Aetna that as of October 1, 2005 they will NO LONGER COVER WLS. If your plan is ending before that date then you won't be approved for the surgery after your renewal date.
Still waiting for my drs office to fax the papers (It's been 3 weeks already!!) but everything should be faxed over tomorrow (4-14-05) so I should hear back soon...Keep your fingers crossed...
Update 4/25/05: I got approved. Technically I waited 11 days to get an approval, so I'm not complaining!! :-) (Rebecca N.)
AETNA - CHOICE II (PA)
(DEBRA A.)
Aetna US Healthcare (PA) - 11/15/03
Aetna is difficult to get approval from. They require at least 6 months of physician supervised dieting within 2 years of approval. If you do not have this, do not bother trying to obtain approval. They will only deny you regardless of your co-morbidities. I recommend that anyone with the slightest interest in the surgery begin a physican supervised diet. The program should include monthly weights as well as a diet diary. Flood the insurance companies with paperwork. (Patricia B.)
Aetna/US Healthcare - MC Open Access (PA) - 05/13/02
(Terra I.)
amerahealth - ppo (PA) - 06/14/06
they were wonderful we started aprogram in the local hospital i worked in the dietatician had no info on the programs she did a lot research and comprised a new area of expertise for her job (Kerry A.)
AmerahealthAdministrators TPA - Valley Preferd (PA) - 08/09/02
so far so good no problems yey but you have to go through a lot of ppl to get the one you need to talk to they were the best only one phone call from the dr office (THANKS ANN) and it was approved right away it must be medicaly necessary and you have to have more that 2 comorbities and thats all folks the ppl were great they were all very helpful and did not mind any of my ?? AMERAHEALTH YOU ROCK !!!!they did not stall at all
i did not have to persue them at all
high recomendation for my ins co...... (kerry a.)
amerihealth (NJ)
(Craig N.)
Aurora Skinner - Aetna US Healthcare (PA) - 02/20/04
(Aurora S.)
bc/bs - Personal Choice PPO (PA) - 07/03/03
(GWEN F.)
BC/BS ACCESS CARE II (PA) - 04/22/06
I FEEL THAT ALL INSURANCES ARE SLOW AT APPROVING THIS KIND OF SURGERY. THE HOSPITAL PART WAS APPROVED QUICKLY IT WAS THE DR. PART THAT TOOK SO LONG. IF YOU HAVE THIS KIND OF INS. KNOW WHAT IS RECOMMENDED AND GET EVERYTHING IN ORDER. (TAMMY L.)
BC/BS of Illinois - PPO (PA) - 09/24/04
I got a letter in 11/2003 stating that I must do a 6 month diet under my PCP. I found out on 1/2004 that it's now a year diet under my PCP.
I decided to call my insurance company back and dig a little deeper as a few people said they had never heard of a year of dieting before being approved by BCBS of IL. I'm glad i lisetend as I got a different story this time around from a very nice young man.
He said I should have my Dr. get all information together and submit it after the 6 months because they go case by case. He said if it's medically necessary and you have been trying to diet and it's not working as I discovered when I got on the scale this morning (up 10lbs)*POUT* then by all means submit all notes to the BCBS of Illinois and they'll review it and make a decision then.
4/2004
BCBS of IL is playing games now. Seems they demand you have a one year diet now. This means while my health goes down hill I must wait until 10/2004 to get my surgery.
09/24/04
BCBS Of IL turned my appeal down.
9/28/04
Resubmitted paper work on 9/28/04 to get me approved for WLS again as I have done my year of deiting. Appealing.
BCBS of IL was not easy to get approved by. I had to do 12 months of dieting and then it took them from 10/04 until 12/04 to give the OK for my surgery. (Cute & Sexy D.)
BC/BS of NJ - PPO (PA) - 09/18/03
(Regina W.)
bcbs - ppo (NJ) - 07/12/05
(kim f.)
BCBSNJ (PA) - 03/16/04
(Melanie A.)
Blue Cross - access II (PA) - 12/16/03
as of 11/10/03 the insurance co. is requiring the type of medically approved diet you were on and proof that it was unsuccessful and how much weight you lost etc. 1/6/04 all info sent to bc/cd. 2/05/04 my surgeon's office is getting the run around. 2/28/04 I call PEBTF to complain because bc/cd tried to dump the delay on them, not true, no they said its up to blue shield, still waiting for review. 3/02/04 Still nothing. 3/26/04 Paper work was lost and had to be resubmitted on 3/26/04. I finally got a response on April 28 and was approved. Surgery date 5/10/04. (Ann f.)
Blue Cross - Horizon (NJ) - 09/28/03
(Tracey S.)
BLUE CROSS - PPO BLUE (PA) - 01/15/2005
Blue Cross kicks butt! My husbands company switched to them in January 05. Previously I had Blue Shield. Blue Shield was a nightmare for me. We switched to BLue Cross and they approved me right away. The people were excellent they really helped me get the necessary info needed. (KARIN V.)
Blue Cross (PA) - 04/22/04
(Tina G.)
Blue Cross - Traditional Plan (NJ) - 07/13/04
(Dawn L.)
Blue Cross - Tina (PA) - 01/16/06
(Tina G.)
Blue Cross - PPO (PA) - 04/02/06
(Tina Marie G.)
blue cross (PA) - 05/02/06
(John R.)
Blue Cross - PPO (PA)
(Cheryl R.)
Blue Cross - Personal Choice (PA)
(Jennifer W.)
Blue Cross - PPO (PA) - 10/11/07
Ann at my Doc office did all the work.It only took one day.
(Royce S. G.)
Blue Cross - Medicare - Personal Choice (PA)
(Denny Y.)
Blue Cross Blue Shield - Access II (PA) - 12/31/03
As of 11/10/03 my doctors office is doing it, so I do not know, will update.
The were great, we had a small delay, but they were great in helping get all the paperwork through. I received the letter within a day or 2. So far so good!!!!!!!!!!!!!
***** After the first letter I got 2 approval letters and a date scheduled then out of the blue I get a denial because of codes or something like that. This is not fair.APPEAL LETTER SENT AND APRROVAL WAS GIVEN. 8 DAYS TO GO!!!!! (Linda P.)
Blue Cross Blue Shield Empire - ppo (PA) - 01/14/02
Dr. Office took care of it all. had an answer in a week (Steven S.)
Capital Blue Cross - PPO (PA) - 04/01/04
(Which Witch I.)
Capital Blue Cross - PPO (PA) - 10/19/04
Dr. Korens office delt with the insurance. I didn't even have to call them.
I don't think they stalled at all.
Capital Blue seems to be very easy to deal with. (Maria F.)
Capital Blue Cross - PPO+ (PA) - 06/04/04
My surgeon's office will do all of the interfacing with Capital Blue Cross. I understand from Mandy Nyce who deals directly with a Capital Blue Cross rep at Easton Hospital, that my insurance company has good coverage for WLS. (Mary S.)
Capital Blue Cross - PPO (PA) - 07/01/04
I really didn't deal with my insurance company. My doctor's office did all of that. (Rafael L.)
Capital Blue Cross - PPO (PA) - 01/18/05
so far so good/nice and willing to help when I called about getting registerd (new company for us as of 1/1/05)/letter sent yesterday/waiting
1/24/05 approved/surgery date of 2/10/05 given (Michelle B.)
Capital Blue Cross - PPO (PA) - 03/29/05
(Jo Ann W.)
Capital Blue Cross - Donna Lyn Saylor (PA) - 04/21/05
(Donna S.)
Capital Blue Cross (PA) - 01/31/06
(Jenn G.)
Capital Blue cross - ppo (PA) - 6/03/07
Very easy.I didnt have to contact them...It only took 4 days for approval (Jessica H.)
Capital Blue Cross - PPO (PA) - 07/10/2007
(Kelly G.)
Capital BlueCross - POS (NJ) - 9-24-04
Aprroved within 3 days!! (Christina S.)
Capitol Blue Cross - PPO (PA) - 02/02/05
I don't know what dealing with the Insurance Company was like because there was a Staff Personel at Dr. Koren's office that handle all of this for me.
It was a breeze.
I would definitely go Capitol Blue Cross (Valerie P.)
COLONIAL HEALTH CARE - FAMILY (PA) - 02/25/04
(nancy k.)
Empire BCBS - EPO (PA) - 5/30/2007
Once my letters, tests and all other material were ready my Dr's office submitted the paperwork, we had to followup with an additional piece of documentation they requested but once that was done the approval was received in short order.
Honestly with the Dr's staff sheparding these cases through the insurance companies this was a fairly painless process. (Mike C.)
Empire Blue Cross Blue Shield - PPO (PA) - 02/16/05
(Michael H.)
EPHN (PA) - 01-06-05
Very satisfied (Gina T.)
First priority health (PA) - 9/1/06
My overall experience was that it was very time consumming due to all the required pre-testing needed before approval. But all things considered I needed very little contact with the insurance company once I chose Dr. Koren as my surgeon because his staff took over all contact with the insurance company and I needed to do nothing more with them directly. (Ralph L.)
Gateway Health Plan - Tracy Hartman (PA) - 09/23/05
(Kathy H.)
Highmark Blue Shield - Preferred (NB) - 05/01/04
I have had a pretty good experience overall so far. My surgeon submitted on the 21st of April, they recieved it on the 26th, and it is still under review. I did call on Thursday and the CSR was very rude, and told me she thought it would be rejected.. how does she know that??????? so.. I was a little upset, but my surgeon's office called and they told her there is no idication it will be rejected, it is still under review. I'll let you know what happens!!!! (Tracey M.)
HIGHMARK BLUE SHIELD - PPO (PA) - 07/02/04
I DID NOT HAVE TO DO ANYTHING. MY DOCTOR'S OFFICE FAXED THE REQUEST LETTER TO THEM MY APPROVAL LETTER WAS WRITTEN EXACLT SEVEN DAYS LATER. (Kathi M.)
HighMark Blue Shield - PPO (NJ) - 04-12-05
I called my insurance everyday, sometimes I will speak to the same person who I had spoken to three days ago. My insurance finally received the paperwork on Monday (04-18-05)and when I called Wednesday (04-20-05) they told me that I was approved on 04-19-05, that was in less than a day. They are very helpful when it comes to giving you information and all. HIGHMARK BLUE SHIELD PPO ROCKS!!!!!!!!!! (Miguel R.)
Horizon BC/Bs of NJ - PPO (PA) - 01/19/05
(Kathy H.)
Horizon BCBS - PPO (NJ) - 5/28/04
BCBS received my info on 4/20/04. I was told that I was approved, but when I called back to verify this I was told that it was still being reviewed. I have been calling on a weekly basis and getting no where. Most of the customer service reps have been nice, but one was pretty rude to me. I spoke to a supervisor today and she was rude too. This process is taking much longer than I expected and I have been told by BCBS that it could take 30-45 business days. Finally APPROVED on 5/28/04 after a call from my surgeon's office to BCBS! (Heather H.)
Horizon BCBS - PPO (NJ) - 07/30/04
(Michelle B.)
Horizon BCBS NJ - Blue Card (NJ) - 06/30/04
I was literally approved for surgery the day after my consultation with the doctor. (Brian D.)
Horizon Blue Cross - PPO (PA) - 06/20/04
(Nanette N.)
Horizon Blue Cross/Blue Shield - Traditional (PA) - 01/13/06
(VALARIE R.)
keystone central bc/bs (PA) - 08/18/04
I had to use my husband's insurance , Anthem since mine didn't pay for the surgery.
I had NO problems with them. I paid 100.00 deductible and 50.00 per day for hospital room totaling 250.00 for the operation. I had to pay the psychologist 200.00 bringing the total to 450.00. I have received no other bills yet at 11 days out. So far I am impressed at the ease of it all. I have my fingers crossed that this is all I'll have to deal with. (susan m.)
Medicare (PA) - 09/24/03
(Lori E.)
Medicare (NJ) - 03/27/04
(Patricia E.)
Medicare - A & B (PA) - 08/04/04
I person I contacted stated no prior auth. required , needed documentation of medical necessity and co-morbidities. She was very helpful and answered all my questions. She explained Medicare part a deductable for the year and part B's co-payments (Maria W.)
Medicare (PA) - 09/17/04
(Audrey W.)
Medicare - Blue Cross Medigap (PA) - 10/23/04
Dr. Koren's office took my Medicare and insurance information and handled everything for me. Everything was apparently approved immediately, because it was less than two months from my initial appointment until my surgery was scheduled (all pre-op testing performed in that time.)
(Marie S.)
Medicare (FL) - 07/17/05
Medicare does not require preapproval for the procedure and ultimately most of your expenses are paid for I have very little out of pocket expenses. In total the surgery and resulting bills cost well over $100,000 but it appears that my out-of-pocket expenses will be about $3,000. (Leanore M.)
Medicare (PA) - 04/13/06
(Bill S.)
Medicare A & B (PA) - 05/23/03
(Dawn L.)
Medicare and gateway (PA) - 05/26/05
(wendy v.)
NJ BBBS - PPO (NJ) - 12/2007
(Mary L.)
United Health - PPO (PA) - 11/17/03
They have a specific department that deals with GBS inquiries, only. It's a small department and they review cases in the order they are received.
I waited four weeks, then followed up with them every week. I don't think it was my persistance, just that they process the claims as soon as they can.
I would recommend United Health to others. (Sue S.)
united health care (PA) - 11/08/03
IT TOOK JUST ABOUT 2 WEEKS FOR APPROVAL
I LOVE UNITED HEALTH CARE!!!
(Ann H.)
Valley Preferred (PA) - 03/28/04
(Debbie B.)
|
|
|
