Financial
counseling and insurance pre-certification
|
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
our patient's comments about how they obtained their surgery. PLEASE
NOTE: These are comments posted by the public. We do not endorse or recommend
any of the companies or agencies below.
AETNA (TN) - 08/02/01
Aetna was really great !!!! I mean I really didnt deal with them a great deal.... The reason it took me 15 weeks to get approved was because it took me a while to get the info to resubmit to them after they denied because they needed proof of dr supervised diets!!!!! After I got my butt in gear though this second time around it only took like 8 working days to get approved. One thing I will say is make sure you document everything. They were really friendly!!!! (Kim J.)
Aetna (TN) - 07/05/01
(Barbara D.)
AETNA HMO (TN) - 02/09/01
It seems like AETNA has everything in order. It only took 4 days from the time that the Dr ofc submitted the paperwork. I just happened to call & they provided me w/ pre-cert #. WOO-HOO (Julie C.)
Aetna Open Choice PPO - PPO (TN) - 04/29/06
Found out today that they want 18 consecutive months of physician supervised diet plans with my prior insurance PHCS so I changed to Aetna and had no problems. (Margaret G.)
Aetna US Healthcare - PPO (KY) - 10/12/01
(Jennifer H.)
aetna/ prudential - epo (TN) - 07/26/01
Happily Dr. dyer is at centennial hospital in nashville who provides a staff just to process these medical claims, so for me things went very smoothly as I didnt have to be the pit bull with the insurnace and the letter the insurance company recieved was already a winner, since the ladies in teh processing office had already written many many letters for others and now know just what the insurance company needs to get a big fat YES (sorry no pun intended> if you live in the Nashville area seek out Dr dyer at Centennial medical center (615)329-7933 (Gavin M.)
Anthem - PPO (KY) - 10-05-05
(Julie W.)
Anthem BC/BS - PPO (KY) - 11/11/05
I was approved the day after I completed their requirements. They were very nice when I spoke with them on the phone. I took the packet from the seminar to my doctor and he used the information I had completed for his letter.
They even covered the surgical consult.
Maybe some day they will cover the psychilogical eval and nutricianal eval since they require it for approval. (Pamela M.)
Anthem BC/BS of KY - PPO (KY) - 07/23/05
(Chuck S.)
Anthem BCBS - PPO (KY) - 01/23/04
(Brown E.)
Anthem BCBS - PPO (KY) - 07/28/04
(Aimee A.)
Anthem BCBS/CA (TN) - 4/23/2007
(Lisa C.)
Anthem Blue Cross - Blue Access (KY) - 04/29/03
I never really dealt with them directly. I called two times to see if they received any of my paperwork and they said they didn't, but gave me a fax number to have the doctor's office send the paperwork to. Once I called my doctor's office, they told me that they had only sent it the day before. I was approved within 48 hours. WOW! (Kim R.)
Anthem Blue Cross and Blue Shield of Kentucky - PPO (KY) - 01/08/05
THE DOCTORS OFFICE ACTUALLY IS WHO DEALT WITH THEM. AND THEY TURNED THE REQUEST DOWN, BECAUSE THEY HAD PUT AN EXCLUSION IN THE POLICY, THAT I WAS NOT AWARE OF.
THEY WANT YOUR MONEY BUT THEY PAY FOR LESS AND LESS SERVICES. (Karen W.)
Anthemn BCBS (KY) - 11/22/05
My insurance was great and I didn't have any problems or compaints. When I called to check on the status of the review, everyone was very helpful and nice. Took 2 months start to finish from seminar to approval of insurance. (Karen K.)
Atena - prudential healthcare (TN) - 05/08/01
I think my insurance co. is wonderful,they have never refused any medications or medical treatment for me. They have told me over the phone that they are waiting to recieve info. from dr's office for request for surgery, and that it is medically needed, they said, it would be approved without any problems. This has helped me greatly, because,i want this surgery now!!!! Approved May 18th. (patricia p.)
BC/BS - PPO (TN) - 02/13/02
I had no problems what so ever with them, I called about two weeks after my doctors office had sent paper work, the nice gentleman told me I was approved and the letter had already been mailed out, the next day, I actually got the letter and was able to fax it to the surgeons office. (Melissa L.)
BC/BS (TN) - 08/09/04
(LDD G.)
BC/BS - FEHBP (TN) - 06/01/05
No problems. (Phillip A.)
BC/BS Bridgestone - PPO (TN) - 07/25/02
I have BC/BS and was approved first letter. I have no serious co morbities. I have a large family history of obesity, and have been trying with my primary care doc for 4 years to lose the weight. I only gained.
After first hearing horror stories about BC/BS I was amazed with the quickness and that I was approved right off. I was very fortunate.
If you have BC/BS and are wanting this surgery my only recommendation is for you to let Dr. Dyer's staff handle dealing with them. Go to his seminar get the info pack and mail it off right away it will take awhile and jsut because you are approved, doesn't mean you have to do it. (Evelyn M.)
BC/BS Excellus - BLUEPPO (TN)
(Tonya Y.)
BC/BS of Alabama - PPO (AL) - 10/15/04
I didn't have any trouble getting approved. It helped that I have been working with my family physician for the past six years to lose weight. I have two physicals in the past six years as well as surgery for osteoarthritis. I sent a three page typed letter along with my medical records to BC/BS to document my co-morbid conditions and to provide further explanation on my attempts to shed weight. (Larry J.)
BC/BS of Texas - James A Mills (TN) - 06/07/2007
(Adrienne M.)
Bc/Bs of TN - PPO (TN) - 02-28-05
They were wonderful!!! I called like mad once Lisa told me that they had sent my information to BC/BS. Lisa sent it on Monday the 7th of February and they had it in hand by the 22nd or 23rd. Why it took so long to get there, who knows, but once it got there, I was approved on the 28th of February- my mom's birthday. Happy Birthday mom!!!!!!
I will say this- prepare all your information as if they were going to deny you on the first application. Lisa told me to send in all I could to give them a full picture of what I had been living with. I wrote a 4 page letter about my weight loss history and had my Jazzercise instructor write a letter pertaining to my comittment to fitness and I also obtained all medical records for the last 5-7 years. BE PREPARED- if you have all your ducks in a row, they can't say no!!! (Bryna G.)
BC/BS TN (TN) - 03/23/05
They were great. My surgeon's office knew what was needed and once she had all the information and submitted it, the approval came very quickly. I was approved within a couple weeks of BC/BS receiving the request. (Miss N.)
BCBS (TN) - 06/30/01
Dr. Olsen's staff took care of everything with my insurance. So I really didn't deal with them. I received an approval letter and I never had to contact them for anything else. (Althea M.)
BCBS - State of TN (TN) - 04/17/03
Self-defeating, difficult, too many contingencies, misleading,economically speaking: words that describe my experiences with BCBS over the past year. I was told that BCBS approved the surgery as long as it is medically necessary. That should have been established, but BCBS requested more info. which has been submitted but that BCBS again requested more support documentation. Now I must figure how to go about getting this info. together shortly. Next time will be the fourth provision of documentation that I or my doc has made.
BCBST responded just to tell me the approval is denied.
Get it in writing.
BCBS has never stalled before now and I can't understand this new "hoop at every turn thing ". It's been six mths. since first letter sent.
I started the process in Feb. 2003 and was finally approved March 8, 2004. BCBS "lost" my paperwork several times, so be sure to continue to check up on things periodically. My PCP wrote three letters of justification and I provided documentation of past diet doctor experiences. Right now, BCBS is saying that the state of TN has put in specific wording in the policy that requires you show that within the past two years you've had multiple failed diet attempts while under the supervision of a doctor who is not a bariatric surgeon, as well as five years of morbid obesity. (I think you can press BCBS on this last one if it is medically necessary and you prove it.) (Susan P.)
BCBS - Rachel W. Lewter (AL) - 09/20/03
The center for Morbid Obesity sent my letter in with all the information being correct, and to the point. My insurance took less than 2 weeks to approve. I recommed an experienced professional do all paperwork. A good medical history is a plus. (Rachel L.)
BCBS - PPO (TN)
(Linda T.)
BCBS - Federal (TN) - 04/07/04
To date I have only called my insurance company to inquire on the requirements for approval. I was told that the only requirement was that I be 100 lbs or more overweight. The surgeons office that I have an appointment with immediately stated "they will cover it" when I told her I have BCBS. We'll see. (Melanie I.)
BCBS - PPO (TN) - 04/21/04
(AMANDA F.)
BCBS - PPO (TN) - 2/24/2004
I am very disappionted with BCBS, I even cringe at the name now. They could have helped be to become a healthier person and the money they would have saved on medication alone would have paid for the cost of the surgery in less than 2 years. Their reply and reason for denial was that the surgery was a cosmetic procedure, even though I had been told by 3 drs that I would most likely not live to be 35. I was 33 at the time of their last denial. (Darlene H.)
BCBS (TN) - 11/23/05
We were approved in 1 week! No complaints whatsoever! (Tina A.)
BCBS - PPO (TN) - 07/02/06
(Josh T.)
BCBS - Blue Care ()
Not even worth fighting. There is a written exclusion policy and we are self funded. If they make an exception for one, then there would be 25 waiting in the wings for the surgery. (Kimberly K.)
BCBS Blue Preffered (TN) - 06/22/01
It was an absolute nightmare dealing with this company. I was quickly denied on the original pre approval letter. They lost all 5 of my appeals letter. I finally contacted the CEO's office and told them I couldn't believe a company of that size could be so incompetent. They found my letters right away (surprise), then denied me again!! In desperation I went to the CEO of my employer and literally threw myself on their mercy. Only then was I approved. (Peggy E.)
BCBS FEB - PPO (TN) - 6/1/06
they were very easy to satisfy for the approval. (kim p.)
bcbs fed - ppo (TN) - 12/26/02
(Gregory H.)
BCBS Fed. (TN) - Aug 9, 2006
Centennial sent my paper work in on July 27, 2006. I waited one week until Aug. 3, 2006 to call BCBS. They told me they did not show anything in the computer yet to give it 2 weeks before I called back. I was only going to wait one week and call back, but to my great suprise Centennial called me on Aug. 9, 2006 to tell my I was approved. That is only 14 days!!!!!!! So fill out all your paperwork, get your letter from your PCP and you should have no trouble. (Joy R.)
BCBS NJ - Horizon NJ (TN) - 2/2/07
You will have to follow-up with your insurance company every week. They are good about telling you they didn't receive all your paperwork. (Felicia M.)
BCBS of Michigan - PPO (TN) - 10/12/04
BCBS of Michigan was very easy to deal with. They are one of few insurances that don't require pre-authorization, you just must meet certain guidelines that they set. (Jennifer M.)
BCBS of NY (TN) - 06/07/06
(Charles D.)
BCBS of Tennessee - PPO Preferred (TN) - 11/02/2000
They have been very, very good to deal with. (Shan B.)
BCBS of Tennessee - PPO (TN) - 10/22/04
Well since they denied me the first time. And I have to appeal. And when I call BCBS rep the gave me the reason for denial is that I need a Psych. Eval. Well I will get one because they say I have to and of course the surgeon wants one also. But the policy never said anything about this at all. So I'm taking it that it's just a stall tactic. They approved me after the appeal was sent in. It took almost a month to be approved then. This isn't one of those cases where everything happens quickly. I've been at this since July of 2004. And now the waiting for the surgery date. But anyone going through this should call , call , call. Not just the insurer but the Center that is dealing with the insurance for you. They all take their time and you have to be persistant. Don't give up! (Nanna S.)
BCBS of Tennessee - PPO (TN) - 08/08/06
(Princess B.)
BCBS of TN (Bridgestone/Firestone) (TN) - 07/07/01
(Jennifer P.)
BCBS PPO - Fed. (KY) - 07/04/05
BCBS PPO Fed. doesn't require pre-determination but it is better to get it. I was approved after 21 days. They require post op paper work but they are pretty good to deal with. (Tara A.)
BCBS Preferred - Bridgestone/Firestone (TN) - 02/27/04
BCBS Customer Service was always pleasant and helpful but the journey would have been easier if they utilized an RN on staff to answer medical questions and give me straight answers as to why my claim was initially denied. I did change physicians which added to the confusion, and in retrospect did not have all my historical data together the way it should have been when initially seeking the bypass. (Paula W.)
BCBS State of TN - state employee (TN) - 3-24-07
(Jennifer B.)
BCBST - State of Tennessee Plan - PPO (NH) - 03/19/2004
Very positive experience in terms of my process. I think that the presence of co-morbities (especially multiples) is a strong indicator of for the terms of meeting their medical necessity clause. (T H.)
Blue Cross - PPO (TN) - 04/25/01
I first applied over two years ago and it took several months to get approved. I chickened out and didn't have the surgery. When I heard it was being done laproscopically, I decided I wanted to have it. Insurance approval was very quick this time--I don't know if that was because of I had been approved before or if they have become more open to the surgery. (Kathy M.)
Blue Cross - PPO (TN) - 09/15/04
(Teresa R.)
Blue Cross - State of TN employees (TN) - 10/25/02
(Pam B.)
Blue Cross (TN) - 08/28/03
(Rhonda C.)
blue cross - ppo (TN) - 06/04/04
I was denied after the first letter as the documentation was not sufficent. They told me to call my provider. So I did and Denise was great. She told me to be positive and that everyone has been denied w/ BCBS on the first letter. It ws a new policy that htye implimented and that they will send my documentation over to them.
They approved me after my first appeal letter. They have been great in explaining everything to me and it was suprisingly faster than i thought it would be. (Danielle C.)
Blue Cross - PPO (TN) - 04/17/04
(Margaret J.)
Blue Cross - PPO (KY) - 05/23/04
(Pamela C.)
Blue Cross - PPO (TN) - 05/25/04
(Lisa E.)
blue cross - ppo (TN) - 08/19/04
My dealings with the insurance company was minimal. Once I faxed my application to Dr Dyers the financial Dept called a number to a nurse at the insurance company from the dept called the review board. They took all the information over the phone. Once I found out that had been done I called the insurance company for two days and on the second day found out my surgery was approved. They didn't have the opportunity to stall because I was going to call everyday if i had to. But I think they gave pretty good service. (crystal g.)
Blue Cross (TN) - 06/13/04
(Angie S.)
Blue Cross - Blue Cross Blue Shield of Alab (TN)
Haven't sent in my information yet but have checked my Policy Booklet and it states will only cover surgery if medically necessary. (Larry W.)
Blue Cross (TN) - 05/30/05
(Rita L.)
BLUE CROSS - BRENDA PETRUS (TN) - 06/25/05
(BRENDA P.)
blue cross - ppo (KY) - 08/02/06
(Pat L.)
Blue Cross - PPO ()
I ended up a cash pay for my Lap Band (Sherry C.)
Blue Cross (Preferred) (TN) - 04/02/01
(Rita L.)
Blue Cross / Rochester - PPO (TN) - 02/28/2008
After 4 years with the same insurance and many, many doctors visits and attempts to lose weight, it was very easy to get it approved. I had the paperwork submitted, they sent a request for a nutritional evaluation. I went on a Friday, it was faxed to them by Monday morning, the letter of approval went out the following Friday. (Dawn G.)
BLUE CROSS BLUE SHEILD (TN) - 03/20/05
(J C.)
Blue Cross Blue Sheild Fed (TN) - 07/16/03
(Sonja K.)
Blue Cross Blue shield - PPO (KY) - 04/11/00
The surgeon's office sent the paperwork 10/21/01. When I called 10/31/01 to check on my approval for another surgery (tonsillectomy at MY age!!!) I was told I was approved, the letter had been sent. Got the letter 11/4/01. They were VERY positive, stated the info sent in by the surgeons office was evidence of necessity. (Denise M.)
Blue Cross Blue Shield - Blue Preferred (TN) - 03/28/2001
Paperwork submitted on Tuesday and was approved on Thursday. No questions asked. Was very surprised to have an approval in such a short period of time. (Melissa L.)
Blue Cross Blue Shield - PPO (TN) - 03/03/01
Dr Olsen's office staff sent the letter to my insurance co. I called Blue Cross Blue Shield after 1 week. I called about every other day to check on the status of it. They were not very helpful, but I did not care. I was finally approved after 3 weeks.
My first consult with Dr. Olsen was denied by BCBS for not being covered in my plan. The diag. code used(morbid obesity)
I called and ask why did they approve the surgery but not the consultation? The insurance rep's response was " You should count your blessing you got approved."
The surgery will be covered but not the consult. Does this make sense? I will be fighting for the consult to be paid!!! (Lara I.)
Blue Cross Blue shield - PPO (TN) - 05/20/01
I was lucky. My insurance company has did a great job so far.
I don't think they stalled whatsoever.
No, I think they do better without persistence.
I would recommend finding a good surgeon and getting
alot of background information about yourself and medically supervised diets.
This will help in the insurance battle.
I will add however, that my insurance would
not pay for my consoltation. (Samantha O.)
Blue Cross Blue Shield (TN) - 09/03/01
They have been pleasant to deal with and easy.
(Cynthia C.)
Blue Cross Blue Shield (TN) - 10/14/01
It is a little hard to get info from them , they switch you from person to person a lot but I have had no real problems with them . They did approve my surgery with only one request so I know I have been blessed. (kim m.)
Blue Cross Blue Shield - PPO (TN) - 08/05/04
(Janell H.)
Blue Cross Blue Shield - PPO (TN) - 02/09/05
It is pure torture dealing with the insurance company. They try to hard to discourage you so you will give up. They "lose" all you paperwork you send in. They ask for something specific and you send it in and then they want something else. My experience is do not send anything except what they ask for and let the doctors office do their job in assisting you with the paperwork. (Teresa C.)
Blue Cross Blue Shield - cummins/fleetguard (TN) - 08/09/05
(Jill H.)
Blue Cross Blue Shield (TN) - 11/17/05
Getting approved really wasn't that hard just
really sitting down and doing it was the hard part. (Pam R.)
Blue Cross Blue Shield (TN) - 11/29/05
(Melvin A.)
Blue Cross Blue Shield (KY)
(Ashley D.)
Blue Cross Blue Shield Federal Employee Program (TN) - 05/24/03
(Eliza W.)
Blue Cross Blue Shield of Georgia - EPO (TN) - 03/29/04
(Laura S.)
Blue Cross Blue Shield of IL - PPO (IL) - 01/19/02
I was accepted right away. My problems began when I began receiving my bills for the surgery. My insurance gave me a letter saying that after my $200. deductable was met, it would be no more than $1,000 out of my pocket. Well I started receiving enormous bills that insurance was not paying what they should. When I called I was told it was a "misquote of benefits" and that within 30 days I would hear whether they would abide by what the letter THEY sent me said. Well of course I did NOT hear from anyone. When I called back, I was told that I now had a deductable that was $750. I said NO I DON"T... well guess what ?? that didn't apply to me.. let me talk to my supervisor and get back to you.. NO getting back. (NO SURPRISE EITHER).. I called again and was told I had another deductable that could go over $800. ... again NO. So the ppl that work in the benefits dept at work said they would deal with it, and that they had this problem last year. When they called insurance they were told that Dr. Dyer and Centennial Med Center IS in my ppo.. then they tried to give them the run around.. like they did me. I am STILL waiting to see what the outcome is. I have paid the $1,000, as I felt was my responsibility.. but am still getting bills from the hosp. and other. I don't blame them.. I would want my money too. I don't know what I would recommend if you have this insurance. I normally would say "get it in writing", but in my case I don't know that writing helped. (Gail S.)
Blue Cross Blue Shield of Illinois - PPO (TN) - 07/27/05
(Kelly W.)
Blue Cross Blue Shield of Michigan - PPO Informed Choice Plan (TN) - 10/2006
BC/BS of Michigan wants "Documentation of professionally or physician supervised weight loss for a minimum of 12 consecutive months, must include periodic weights, dietary therapy, physical exercise and behavioral therapy". BMI 35 or greater with co-morbid condition..., BMI of 40 or greater, Ages 16 to 60, Psych. eval., Documentation that PCP & patient understand the risks and reasonable expectations, and Lap-band is covered. This is as of May of 2004. (Robin K.)
Blue Cross Blue Shield of Tennessee - Blue Network P (TN) - 02/12/05
(Retta i.)
Blue Cross Blue Shield of TN - PPO (TN) - 11-14-05
(Lura B.)
Blue Cross Blue Shield of Tn - PPO (TN) - 01/23/06
(Melissa C.)
Blue Cross Blue Shield of TN - PPO (TN) - 03/06/06
The customer service folks at BCBS have been wonderful. They were very helpful and encouraged my phone calls. My information was approved after being in the system four days. There was no stall in the slightest. My one and only suggestion is to make sure you have all your documentation, all your information and give them exactly what they are looking for. (Marianne H.)
Blue Cross Federal (TN) - 05/15/04
(Lee Ann H.)
Blue Cross Federal - PPO (TN) - 11/22/04
I had NO problems
n/a
n/a
I thought it was too good to be true. Seems it will be, as I just got an email BC/BS Fed will no longer approve any surgeries as of January 2005. I am glad things went thorough smoothly for me, the first time. (Donna M.)
Blue Cross MN - PPO (TN) - 03/31/06
This was my second surgeon as the first one was not able to do it based on their change in requiring the surgeon to be a blue center of excellence. I'm not sure if this made a difference as my information had been reviewed in the past, but this was painfully easy. They had approved it even before the grace period for them receiving the information. (Eric R.)
Blue Cross of CA - PPO ()
(TPin T.)
BLUE CROSS OF GA - PPO (TN) - 11/22/04
(LAVONYA S.)
Blue Cross of New Jersey - PPO (TN) - 08/10/04
(tracey l t.)
Blue Cross of SC (TN) - 11/03/03
(Angela H.)
Blue Cross of Tenn - Blue Preferred (TN) - 03/30/01
My particular policy did not have an exclusion clause, although that is mostly up to the employer when they initiate the policy from what I understand. I did not feel that they stalled, but it did take two full weeks for them to log the request, review the medical necessity, and then respond to me. The first thing to do is to determine if you have an exclusion clause w/ your specific group policy. If not, then you must document medical necessity to be approved and it helps if there are co-morbidities along w/ the BMI 40 plus. (Susan I.)
Blue Cross of Tennessee - Preffered P Network (TN) - 09/07/2006
They denied my original requests. I chose a new doctor so they did the appeal. I had to gather my own documents from my PCP and faxed them into BC. The reps always say it takes 7-14 business days. It seems to take about 7 business days to get the denial. I called every day, sometimes 2x a day. One rep tried to tell me not to call back, but I said I would call the next day and maybe I'd even talk to her again! I think it was a stall tactic, but it seems they did not review my medical records. Perhaps if you don't send your entire medical records and only send what they request. Don't forget the letter from your doctor showing initial body weight, final body weight and you met your 10% weight loss, and that he was aware of your conservative diets and attempts at weight loss within the past 2 yrs. They do want this! Do not give up. Fight for yourself. Be diligent. Even if you think you are driving others crazy. Don't give up. (Melinda R.)
Blue Cross Preferred - PPO (TN) - 01/22/02
(sheila p.)
Blue Cross State of TN - PPO (TN) - 06/02/04
(Daniel E.)
BLue Cross- Anthem - PPO (KY) - 09/09/05
(Angie S.)
Blue Cross/Blue Shield - BluePreferred (TN) - 2/05/2001
I have had a great deal of trouble getting any information from this company. I have had to be very persistent, well informed of the laws (disability, equal rights, etc) and very sure of myself in order to get anything done. However, I now know that part of the problem was my husband's employer. Their specific policy had an exclusion in it that Blue Cross refused to budge on. Once the employer changed the policy to covering gastric bypass w/ medical necessity it didn't take any time at all to get an approval. (Michele D.)
Blue Cross/Blue Shield - Federal Employee Program (TN) - 08/22/03
(Lori F.)
Blue Cross/Blue Shield - Blue PPO (TN) - 09/05/03
I have found out that BC/BS PPO Blue is impossible to deal with. I had a profile that proved beyond any doubt that my surgery was medically necessary, but was still denied. I can't understand why an insurance company would continue treating all the co-morbidities you have, but refuse to correct them. I have been lied to, told to call back in two weeks, etc., with the same answer,your case is going before the board next month,only to find out that it was already denied. I'm planning on filing a complaint with Tennesse Insurance Board. It want hurt BS/BC, but will make me feel better. Sorry Insurance. (Carolyn W.)
BLUE CROSS/BLUE SHIELD - PPO (IN) - 04/19/04
I wanted the process to be faster than it was as I was anxious. I was denied the first time. The appeal letter was writtem by Dr. Houston's office but the people at the INAMED hotline really worked hard to get the lap band approved for my. Anyone trying to get approved for lap band should contact the people at the hotline.
I don't think persistence had anything to do with the approval. I honestly believe that my work might have had something to do with the approval. Coca-Cola is self insured and BCBS manages the policy. If my appeal had been denied the second time, I would have had to appeal it with Coke's benefits committee. (TAMMY J.)
Blue Cross/Blue Shield (TN) - 11/26/04
(Holly E.)
Blue Cross/Blue Shield Bridgestone (TN) - 04/15/05
I had my seminar on April the 26th and got approval after 1st letter on June 16th, 2005. I kept calling them after I knew paperwork was in and they were always very nice to me. I would just suggest you give them a call about twice a week after you know all paperwork is in. (Virginia R.)
Blue Cross/Blue Shield of SC - PPO (TN)
(Kym B.)
Blue Cross/Blue Shield of TN - Preferred (TN) - 04/27/01
I haven't had to deal with them at all. My policy states wls if medically necessary and that they have 5 days to approve/deny. Centennial filed my papers last week and called me this morning to tell me I was approved. BCBSTn has been good for us in all other health matters and I had only hoped it would be the same for wls. And it is!!! (Pamela W.)
Blue Cross/Tennessee (TN) - 04/08/04
Keep calling until you get a nice person. Some of them are bitches and won't help you, but there are nice ones. Let them feel like they know you, speak to them like a friend. They have a set list of criteria that has to be met and sent in, but won't tell you about what it is. I found out that if you go to their website and click on the link for doctors and medical personnel instead of patients, you can find the criteria (I found this after about 6 months and about 10 phone calls.) They definitely respond to persistence--if they know you're really interested and have called a lot, they are more likely to help you or let you speak to a supervisor about what you're missing from your file.
***I know that after the end of 2004, they probably won't be okaying this surgery any longer, because of so many requests, so if you are thinking of it, you'd better get your act together and get it completed before then. If you get turned down, call until someone will tell you what you're missing from your file. Don't let time pass or you'll run out. (Janie G.)
blue shield of ky (TN) - 07/10/04
had to see the doctor,dieitican,and phycologist before insurance would give approval.they wanted to make sure i was sure i could handle the surgery and make that decision.i had letters from each of my doctors that the agreed with me that the surgery for weight lose would help and letters of documetation of previous diets of weight lose and gain.everything was ready before it was sent out to doctors.sleep apnea ttests,heart doctor tests,the more the better. (Barbara B.)
BlueCross Blue Shield - PPO Blue Preferred (TN) - 04/13/01
(Rachel M.)
Cigna - epp (TN) - 05/02/01
Up until now, they have basically been very good, except that our rates went up in May.
Received a denial letter 9-19-01. Letter was so long, it was hard to tell exactly why they denied, but I think that they think that I have not tried dieting enough.
PCP called me at work this morning, 10-23-01, and told me that insurance had called her and I had been approved. Received approval letter a couple of days later. I must say that I really haven't had any problems with this insurance company even after hearing all the horror stories about Cigna. I believe it's all in your company's policy. They've been great for me thus far.
(Katherine K.)
Cigna - PPO (TN) - 06/04/01
I have the CIGNA PPO for my health insurance and although there were a few bumps in the road, overall the process went fairly quickly. I sent in my information and checked on it one week after I sent it in and they could not find it. I talked with a super nice rep and she said if I would fax it to her directly, she would expedite it since it was lost the first time and ask for a "rush" decision. I sent it and 4 days later she let me know she had received it. She forwarded it to the dept. that handles predetermination claims and the 72 hour "rush" review actually turned out to take @ 8 days. I was approved on the first letter though and did not have to do anything else except see the surgeon and schedule a date for surgery. The whole process took a little over 2 weeks and overall, this went fairly smoothly. I did have to make several calls to follow up and I would say I was probably perceived as pretty pushy on the phone by the reps at CIGNA. However, I did not really feel they were stalling, I just felt like they were doing all they could and my case was caught up in the "paper hell" that seems to be the case at all insurance companies. (Angela R.)
Cigna - HMO (TN) - 06/06/01
(Jennifer F.)
Cigna - Cigna (TN) - 10/06/01
Well I really thought I would have a terrible time with my insurance company.I have read several enteries of people dealing with Cigna HMO..and they were not pleasant at all.But I sent my insurance infomation to an individual by the name of Debbie Thompson who works with Dr.Dyer.After the first 3 days she email me and told me that Cigna wanted my medical history for the last 5 years..And it took me 3 weeks to get all the medical records released..So I waited and waited and waited.Debbie told me to call the insurance company myself since she had not heard anything yet.Well to my surprise when I called they did not only tell me I was approved...I was approved at 100%.The hardest part of the whole approval thing for me was get the medical records and that was it..Now I'm just waiting to have surgery..I hope everyone's approval is as easy as mine has been..Good Luck
(Kellie C.)
CIGNA - HMO (TN) - 03/09/02
I didn't have any problems dealing with CIGNA of TN...they approved my surgery on the first try. I did provide them with TONS of information..including medical records dating back to high school. (Wendy C.)
Cigna - PPO (TN) - 05/07/02
My first request was denied, "lacking information". My Internist said that all insurance companies like to deny the first request for any "non-emergeny" procedure.
She wrote the same information again, in FULL 2 page detail and I was approved. The whole process from deciding to go through with the surgery to actually getting approved took about 5 months. I went to my first gastric bypass seminar in Sept 01 and my surgery was April 23, 02. (Julie M.)
Cigna - Connecticut Life (TN) - 05/11/04
(Shannon G.)
cigna - ppo (TN) - 07/28/04
(Heather P.)
cigna (TN) - 09/22/04
cigna was very difficult to deal with. we have a lady now that is on it and can't have the surgery.
took a year to get fully approved.
no. this lady that I am talking about even had a case manager from Cigna
keep trying if possible. (angela r.)
Cigna - PPO (TN) - 09/27/04
Cigna was great in aproving the Gastric By-Pass Surgery. The approval board received my paperwork on a Monday afternoon and I had approval on Wednesday morning of the SAME week!!!! (Cheryl R.)
Cigna - PPO (TN) - 01/15/05
I believe my case was approved because of another lady ahead of me had appealed Cigna's decision to not approve her surgery. With the help of Dr. Dyer's staff in the appeal, Cigna made the decision to approve the surgery. (Cheryl D.)
Cigna - PPO (TN) - 01/18/05
It was very easy. I had everything they asked for and sent it all in at one time. It took them 9 days to show they had received my fax in their system. 2 days after it showed in their system I was APPROVED! (christie t.)
Cigna - PPO (TN) - 11/04/05
I had so many co-morbidities and my insurance carrier was spending so much money on my monthly prescriptions and insulin pump and Dr's visists that it was a fairly quick decision to allow me to have the surgery to stop all my future increasing complications due to my multiple co-morbidities. I was denied the first time but I am told that everyone gets denied the first time. I was also documented as having tried and failed on Dr prescribed diets in the past, so I was not required to follow a mandatory 6 month Dr prescribed weight loss program.
The only thing I felt good have gone better was that I was approved for 3 weeks before I called and told I had been approved 3 weeks before....I wish the insurance carrier would have sent me an approval letter or a phone call to let me know of my approval sooner.
I was very disappointed in Centennial Center for Obesity's financial helper who I had to leave multiple messages for and pray and hope for a response...and then to be told that I needed to call myself to the insurance carrier....I understood that the financial counselor at the Obesity Center at Centennial was the go-between for me and the insurance carrier...??? (Angel P.)
Cigna Healthcare - HMO (TN) - 11/12/04
I fought for over three years with Cigna before I was finally approved for WLS. When I initially sought approval, I weight upwards of 350 pounds and had been dieting nearly all of my life. I had several proven co-morbidities; yet my first denial letter stated that there were none, and that I did not have enough documented attempts at weight loss. Thus, I began seeing my PCP on a monthly basis to prove additional weight loss attempts. At that time, I went on Phenteremine and literally quit eating so that I could show that I was trying. In the ensuing six-month period, I lost over 70 pounds; and appealed the denial. When the decision came back, I was denied because I had already lost so much weight. The denial letter stated that if I hit a plateau or began gaining the weight back (which I had always done in the past), I could seek approval again. I appealed that decision; and after about six months of going back and forth with them, I lost two more appeals.
I kept taking that Phenteremine and keeping my monthly appointments with my doctor so that I could show continued weight loss attempts. After about six more months, I again petitioned to Cigna to have the surgery. I was once again denied due to lack of weight loss attemtps and co-morbidities. To no avail, I went through the entire appeals process again, which took approximately nine more months. By this time, I had hit a plateau; yet in the end, I was denied on the same grounds.
By the time my third attempt to have the surgery rolled around, I had indeed began to gain back some of the weight because I had to start eating a little more or die. I was continuing to take the Phenteremine and go to my PCP on a monthly basis, but I still gained forty pounds. I applied to have the surgery again, and was denied due to lack of weight loss attempts and co-morbidities. I went round and round with them for another six months, and received two denials. On my final appeal, I was granted a peer-to-peer review with my surgeon, myself, the Director and Coordinator of the surgeon's weight loss program, the Medical Director at Cigna, and a three member review panel at Cigna. At the appeal review, my surgeon stood up for me and let Cigna know that, although they were denying me on those particular grounds, I did indeed have the required co-morbidities and, further, he had never seen a patient with more documented weight loss attempts. The members of the panel said that they would take it under advisement and inform me of their decision within five days. That same day, I received a call from my surgeon letting me know that Cigna called him and had finally approved my surgery.
Although I did everything Cigna required of me in order to have the surgery, I perosnally believe they were denying me simply because they could. They hoped that I would finally give up and stop trying to have the surgery. In the end, though, my persistance paid off, and I was finally able to have the surgery that I had fought so long for.
(Debbie R.)
Coresource (TN) - 06-01
(Kathy R.)
Empire BCBS (TN)
My insurance was the best to deal with. They did things a little different then what I have read about.
They required me to have the Psych eval and the other tests first and then submit everything all together. I was approved within one week of all the paperwork being submitted.
Super people to deal with at Centennial too. The Financial officer, Candy Weber, worked really hard on my case to get me approved in record time.
I commend everyone for being so diligent. (tannis z.)
Empire Blue Cross Blue Shield - PPO (TN) - April 23, 2007
The entire process was a breeze. Once the insurance company received the information, the responded within a 2 hour time span to both me and the doctor's office with an approval status. The financial counselor with whom I had been working stated this was the quickest response she had ever seen. I would highly recommend this company to others as they are very cordial and amicable. (Sharon C.)
First Health (KS) - November 4, 2005
(Gene H.)
First Health - PPO (TN) - 9/16/02
I didn't have to deal with them at all. Dr. Dyer's office took care of getting me pre-certified, so I had no problems. (Andi S.)
First Health - PPO (TN) - 12/03/02
They required that I have my consultation and psychological evaluation before submitting the paper work for approval. The paperwork was faxed to them on Thursday and the following Tuesday Dr Olsen's office called to schedule surgery because it was approved. (Laura J.)
First Health (TN) - 09/29/03
Dr. Houston office staff took care of most of the paper work and sent everything in. They were very effecient. One of his office staff called me and notified me of my approval, then I recieved a letter from my insurance company within a few days. The whole process took about 2 1/2 weeks. (Janice M.)
First Health (TN) - 12/24/04
First Health was very prompt with their decision. They do require the psy eval, nutrition screen and a letter of medical necessity from your primary care physician with the history of weight loss attempts over the last several years. Also request a copy of your medical records from your PCP for at least the last 5 years. All this must be submitted with your pre-auth. (Mary P.)
First Health - HCA - PPO (TN) - 10/24/03
The insurance company has been pretty good. There is a $20,000 cap on the surgery and the costs associated with it. (Candace (Candi) W.)
Fiserv health - PPO (TN) - 09/25/02
My insurance was great. I had no problems what so ever. Approved me with 1st letter. Kim Henry was the lady I spoke with at the Ins Co. and she took care of everything. Wonderful lady. (Hope I'm so lucky with plastic surgery approval.) Right before my surgery Dr Dyers nurse had to call a different # to get pre-cert and they told her I had to prove medical necessity, had to change my surgery date and had to do a appeal and the MD at that # still said " no try again next year" well all this made no since to me, the 1st company said I was approved but then this one said no. Whats up with that? Well I called Kim Henry at Fiserv and she was very upset and called the other people. I dont know what was said but within 10 minutes the other place called me apolgizing and telling me I was precertified for 3 nights in the hospital. God Bless Kim Henry!!!!!!! (Carrie W.)
Fiserv Health - Community PPO (TN) - 03/15/03
I met the criteria and they approved the surgery for me. There was no hassle. My insurance company was friendly and helpful.
My insurance company, Willis Coroon, was bought out by Fiserve Health. I get to keep my approval for the surgery. (Pam T.)
Fiserv Health-Kansas - PPO (TN) - 01-19-2004
It was really great. My contact person, Cathy, was friendly and efficient. There was no hassle at all, which was surprising after all of the horror stories that I have heard about. I did my part and gathered all of the info. that they would need to make thst decision, and they approved me in a timely manner. Which was really wonderful of them. (Brandi I.)
Fortis - PPO (TN) - 09/04/01
(Mikki B.)
GEHA - Federal (TN) - 10/19/04
GEHA has been very responsive to the surgery so far. (Alice P.)
Great West - PPO (TN) - 12/18/01
Dealing with the insurance company was very slow, they lost my paper work twice. I had a hard time getting a hold of the person that was in charge of the approval process. If any one is trying to get approved through Great West make sure you have your Phyic. evaluation and also include a dicription of the surgery with your paper work. You can get this information through the Bariatric department of Centennial Hospital. This will save you at least 4 to 5 weeks of the process. (Kimberly P.)
Great West - One Plan Open Access (TN) - 04/25/03
I had heard that GW was famous for stalling, so took a frontal attack position. I was given bad info the first time I called - they said only needed a letter of medical necessity. When I called back, they told me they needed a psych. screening and 3-4 years of documented diet attempts. They approved me 2 days after receiving all they needed. (Rachael B.)
Great West (KY) - 6/24/06
I started this process in late 2003 and became discouraged when the surgeon I was working with at the time submitted my request to insurance before all medical tests were completed, thereby successfully obtaining a denial for me. (Thank goodness as it just wasn't meant to be at that time with that particular surgeon.) After the denial in 2003, I decided I could do it myself and made some attempts but only to loose a few pounds here and there. Over time I gained more weight and developed a problem with my left foot (achiles tendonitis) which caused exercise to be even more painful, etc. After being diagnosed with that and realizing I simply had to do something or I wasn't going to even be able to walk, I decided to dust myself off and made a second attempt for surgery approval. I contaced my ins. company to see what their most updated requirements were and went over them with a fine tooth comb. I then contacted my new surgeon's ofc who by this time has become a nationally certified bariatric weight loss center and has everything in place to assist you with meeting the strict requirements of the insurance company. I was required to go through a very strict six month process of working with a nutritionist, a physiologist, a psychiatrist, all kinds of support people to help prepare me for this journey. And while I did not like the thought of being six months out from surgery at best, now that I'm on the opposite side of it all, I better understand their reasoning. After I completed my 6 month requirement the end of March, 2006, my surgeon's office got all of my paperwork in order for me and submitted to ins. company. I believe it was submitted around the first of May via telephone (per ins. company requirements). Then after they review it over the telephone they called my drs ofc to have them to submit the actual paperwork via fax. This was about May 14, 2006. Upon first word from insurance company they denied me because the reviewer didn't see two things in my stack of paperwork that my drs ofc and my case manager knew were there. They allowed my drs ofc to submit those documents again and luckly the reviewed looked it over again the following afternoon and wah-lah! Thank heavens!!! I was determined to see this through once and for all this time and I'd followed everything to the T (with the help of the staff in my surgeon's office). I did make a couple of calls initially to the case manager who was assigned to my case when it was first submitted to my ins. company. However, I could only reach her voicemail and she NEVER once returned my call to acknowledge my call or my claim. It was frustrating from the start too as my surgeon's office was unable to reach her for many days to even get an acknowledgement that they'd rec'd my claim. Common courtesy seems to be on the bottom of their list - even to my surgeon's office. I was very courteous when I made the first call but by the time I called the second time, I was pretty much to the point. The way I looked at it was I'm the client (as the insured) and they work for me. (DH's company is self-insured - this company simply administers the claims.) I did feel there was some stalling and it appeared from something that was said that the reviewer only works in this particular office on certain days. So it made me think that I had to wait my turn for him to work in this particular location and work his way to my paperwork. I do feel that they knew that my surgeon's office was very knowledgeable in what they're doing so I definitely think that helped!!!! (Unlike with my first attempt with the wrong surgeon!) (Bonita N.)
Health Cost Solutions - PCHS (TN) - 11/08/04
(Mike S.)
Health Risk Management - PPO (TN) - 03/22/01
(Anita C.)
HealthCost Solutions (TN) - 12/07/04
Our insurance company was a real drag to work with. They dragged their feet on every step. It seemed like every time we jumped through one of their hoops, they'd pull out another one for us to jump.
We feel like they were trying to delay the surgeries because we had already met our total out-of-pocket expenses. (That is just our opinion based on our experience, not a proven fact)
If anyone else uses this company, be prepared to fight for your life. (Cathy S.)
HealthSpring - Freedom plan (TN) - 02/19/04
I question HealthSpring's competency in dealing with bariatric issues. The first denial stated that I did not have a BMI of 40 (no mention of an exclusion policy). I also have 2 co-morbidities--documentation was submitted. Apparently co-morbidities do not enter into their calculations. I never received a notice of the second denial although they had sent a letter to the Bariatric Center (who submitted all of my paperwork). I understand, after speaking with the Bariatric Center, that HealthSpring's reason for the second denial was that WLS is excluded from my policy. So...why didn't they state that in the first place?
Yes, I feel like I got the run-around from this company. If you have HealthSpring and are morbidly obese, find another insurer.
(Debi H.)
Horizon Blue Cross Blue Shield of NJ - Blue Card PPO (TN) - 1/29/07
Started the process with BCBS on January 9th. I called on January 22 to check on the progress and the customer service rep promised someone would call me back that afternoon. (Should have been a red flag) No call on the 22nd so I call again on the 23rd. After finally convincing the person that I was the patient and not the surgeon, I get connected to a very helpful lady who looks through my records and informs me that she's not showing they have received anything from Dr. Houston's office. I contact Lisa at Centennial Medical Center and she contacts BCBS directly. Apparently, there had been a problem with their automated pre-cert system and they haven't been able to recover any of the information. Lisa then starts the process again, this time with an actual person, and lets me know that things are once again underway.
Playing dumb to the situation, I call on the 24th to see how my pre-certification is progressing. Unfortunately, I get connected with a rather curt, unfriendly, and completely unhelpful rep who gives me contradictory information about their submission process and system problems. I could tell from her voice that having to deal with me was an annoyance and she wanted to end the call as soon as possible. How nice it was that I was selected to participate in a customer service survey at the end of my call. :o)
**Update** 1/29/07
It took a few tries but BCBS finally got the information and I got to talk to Sherry, the nurse reviewing my case. She promised that she would try and have an answer for me "Monday or Tuesday" and she kept her word -- She called me just before Noon to tell me that I had been approved!!!!
(Joe E.)
Humana - PPO (TN) - 04/21/04
(Melissa T.)
humana - ppo (KY) - 06/15/04
HAD A GREAT TURN OUT WITH THEM.ONLY TOOK ABOUT 3 WEEKS TO GET THE APPROVAL. (LISA D.)
Humana - Risa L. Woodward (TN) - 08/18/04
Unfortunately, about a month after my surgery, I received a letter stating that Humana would no longer cover weight loss surgery. (Risa W.)
Humana - ppo (TN) - 11/10/04
Weight Loss Surgery was written in my policy with Humana. AS with all carriers, each company's policy is not created equally.
I knew it was included and knew I fit the CDC criteria and would be approved.
I would recommend you know your policy with your employer and even discuss inclusion with HR to see if it is possible. Especially when they value the amount of sick time you could be off due to the co-morbidities (Tracey C.)
Humana - PPO (TN) - 06/05/06
(Janith G.)
Humana (TN) - 08/15/2006
(Paula W.)
Humana (KY) - 09/22/2006
Approved first attempt. We did have complete history and documentation prior to submittal. (Andy S.)
Humana - PPO ()
I was so worried about the Insurance approving the surgery. I had gone through my 6 month pre-op requirements, I had gathered all the information necessary, I had done everything right, but I was very worried that they would not approve me. I didn't quite meet the BMI requirements, but I did have co-morbidities. The surgeons office let me know that they had sent in the letter and documentation and I could NOT believe it when she called the NEXT DAY and told me I had been approved. Yes, the NEXT DAY! Thank you Humana. (Jane T.)
HUMANA HCA - PPO (KY)
(TONYA W.)
J.F. Malloy - PPO (TN) - 02/09/02
(Dana H.)
JDH - HMO (TN) - 3/7/03
JDH Has been Great! There were two reps who work for JDH who did an OUTSTANDING JOB Marilyn and Margaret THANK YOU SOOOO MUCH!!! They went above and beyond anything I could have asked for. You all are great thanks JDH. It must be medically necessary and if so they will be there for you. (Shannon E.)
Ky Access - Premier Access (KY) - 1/29/04
The staff in the pre-approval department has been very easy to work with. I spoke with them on the phone several times. They required me to complete the psycholigical evaluation and a nutrional evaluation before approval. Once they receive all the information from the doctor they received my complete information on tuesday and I had an answer on friday. I appreciate their thorough evaluation of all the facts.
7/1/04 Kentucky Access has been one of the worst insurance companies I have ever seen about fighting you to keep from paying the bills. They tried to say my weight loss was a pre-existing condition, after they approved it before the surgery. Now they are only wanting to pay a small amount of the surgeon fees and keep giving the hospital the run around. This group is managed by Anthem. If you have Kentucky Access or Anthem be prepared. (Alan W.)
Mail Handlers/First Health (TN) - 03/21/05
My letter was submitted and within 4 business days I had my letter of approval. No questions asked. These people were excellent and easy to deal with. I was very pleased. (Tom M.)
MEDICARE - A&B () - 06/24/03
FOR SECOND TIME I WAS DENIED FOR THIS SURGERY PEOPLE IF HAVE FEDERAL ATNA US
HEALTHCARE THROUGH THE VA HOSPITAL OR ANY FEDERAL AGENT.
GET RIT OF IT NOBODY IN MURFREESBORO TENN ACCEPTS THIS INSURANCE.
THEY WILL NOT APPROVE ANY THING UNLESS YOU GO TO THERE DOCTORS.
I FOUND NOBODY THAT ACCEPTS THIS INSURANCE (pam j.)
medicare - a&b (TN) - 05/31/04
(STEWART C.)
Medicare - & BCBS Federal (TN) - 08/03/04
I got pre-approval in one week. BCBS Federal is no problem as long as you meet the guidelines. Medicare will approve if medically necessary. Getting approved was a breeze for me. Went from seminar to surgery in 28 days! (Jeanette K.)
medicare (TN) - 03/18/05
(allenia m.)
medicare (TN)
(arianna k.)
medicare a/cigna health care - medicare (TN) - 06/10/04
cant even find a doctor to talk with at this time. cigna would not pay anything they said they did not have enough info to pay for it i talked to medicare which is my primary ins and they said they would cover it and that i had to pay the doctors part because he did not take medicare. (janice p.)
medicare/ Blue care (TN) - 05/06/01
(Linda O.)
None (TN) - 04/15/02
(kendal s.)
north american (KY) - 10/27/04
north american was wonderful, it only took so long because they didn't recieve all my info like i was told.once they called the doctors office an had the girl fax it then it was approved in 2 weeks. (Heather T.)
Pacific Life - PPO (TN) - 05/16/04
(elizabeth d.)
PAID CASH (TN) - 01/19/05
(DAMON T.)
PHCS - PPO (TN) - 11/10/04
BC/BS was not very helpful. They approved a woman that I worked with and denied me for more info twice. They said that the other woman (which i did not give her name to them) was approved by mistake. well that means that Blue Cross was not up on things. (Jacqueline S.)
Principal Financial - Private Healthcare Systems (TN) - 05/19/03
I had to change my insurance from HMO to PPO and as soon as my doctor got the paper work ready and finally sent it off...It took 1 whole week to get there and get into the computer ....Then it took 4 long days of calling everyday to find out and yehhh I got appoved.... (Misty H.)
Principal Financial - ppo (TN) - 7/9/04
The ins was very easy to deal with. I had to refax letter from pcp. After they received that I was approved in 2 weeks. The nurse at the ins co called to tell me I was approved and faxed the approval letter to my surgeon 15 min later. I give my ins co an A++ (First M.)
Private Healthcare Systems-GE Group (formerley Ph - PPO (TN) - 01/09/0
The doctor's office faxed them my information on Feb. 28, 2001.
After a couple of snags...wrong fax number, not getting faxes, I got my approval on April 16, 2001. (Dana D.)
PRUDENTIAL - JANET COLEMAN (TN) - 02/28/01
PRUDENTIAL SEEMS TO BE A GOOD INSURANCE, AT FIRST THEY WERE ONLY GONNA PAY FOR THE OPEN, THAT KINDA UPSET ME, BUT WHAT THE HECK I WANTED THE SURGERY SO I WAS GONNA HAVE IT ONE WAY OR THE OTHER. THEY STARTED OUT ONLY APPROVING THE CONSULT DATE FIRST. SO I WAS WORRIED ABOUT THAT, THEN THEY SENT ME A LETTER SAYING THAT DR DYER NEEDED TO SEND IN ADDITIONAL INFORMATION IN ORDER FOR THEM TO APPROVE THE SURGERY. WELL IN THE MEAN TIME I GOT TO SEE DR DYER AND THEY WENT AHEAD AND GOT ME A DATE FOR SURGERY, THAT WAS COOL. ABOUT THREE WEEKS LATER I GOT THE WORD THAT I WAS 100% APPROVED. THAT WAS A HAPPY DAY FO0R ME.EVERYONE AT THE INSURANCE COMPANY SEEM TO BE VERY NICE AND THAT'S ALL I GOT TO SAY FOR RIGHT NOW GOD BLESS (JANET C.)
Samuel R. Colley - Blue Cross Blue Shield of Mich (KY) - 07/04/03
No problems. (Cherie .)
Self Pay (TN) - 12/10/02
(Jenny B.)
Self Pay (TN)
(Samantha G.)
Signature Alliance Healthcare (TN) - 03/11/01
This ins used to be my secondary but now since I am stayin at home they are now my primary. I had NO trouble at all gettin approval form this insurance company and after my surgery they are sending someone to the hospital to see how I am doing. Seems like good treatment from an Insurance company. (Rhonda T.)
Tenn Care Select (TN) - 05/22/05
(Monica D.)
Tenncare Select (TN) - 08/18/04
(Eva O.)
The First Health Network - PPO (TN) - 8-9-02
(Marie S.)
Tricare (TN) - 03/12/01
I was very pleased in my dealings with Tricare. They have a hotline 1-800-444-5445, so you can call in and check the status of your request four days after it is submitted. They certainly didn't stall. Since they are a government/military agency, I had expected a long wait and a lot of hassle. I got neither. (Judith A.)
UHC (IL) - 05/03/06
I was orginally approved in 2004 but decided to not follow thru. I started the process again in 11/05 and approval was given 4/06. I followed their instructions precisely. Then there was a slight kink a few days before my first visit with Dr. Houston. I spent 3-4 hours on the phone with 7 different people at UHC but finally approval was given. Needless to say, it was not a good 3 plus hours but the outcome was 'I WAS APPROVED'. I saw Dr. Houston on Fri. 4/28. What a great day and what a confident surgeon. I was impressed to say the least!
6/1/06 I decided to call United Health Care since my surgery date of 6/6 is quickly approaching. Plus, I had asked for a copy of my approval letter in April and still did not receive it. Well, here we go AGAIN....after speaking to 3 people, I was told it was denied. Even after I had my PCP's nurse on 4/21 get the ref. # when she was instructed to call UHC indicating the dr. was referring me to Dr. Houston. I ended up talking to 4 people this morning and the last person ASSURED me this morning that a lady by the name of Janet would return my call today. Since it was after 4:30pm and I was going to leave work, I decided to call again....and demanded that they fax me the approval letter. I definitely believe we as insureds need to tell the insurance companies that WE ARE TAPING their conversations because these people are clueless. So the bottom line is....after 7 hours on 2 different occasions on the phone waiting for UHC to get their act together, I was faxed the approval letter. If I was a drinker, I'd have one tonight : ))))))
After receiving confirmation numbers and a letter, UHC told Centennial AFTER my surgery that they are denying my claim. In fact, just last week I received 2 denial letters. I work for a large worldwide company and I know my company has received sooooo many complaints against UHC. They'll have one more when I feel up to calling them. This is sad but I know I'll take care of it. I feel bad for the dr. and hospital as I struggle to get UHC to pay their bills. It's not fun and especially not fun when you are recovering from major surgery.
8/1/06 - I continue to be VERY upset with UHC as they have again denied my coverage AFTER approving it previously. I am filing an appeal. This saddens me as I need to focus on my health and not their lack of organization. As I mentioned, I was approved and then AFTER my surgery, I was denied.
9/27/06 - Today UHC finally RE-APPROVED my surgery from 6/6/06. This was a real challenge and I know perseverance is the key and lots of patience plus I can't say enough that you need to document, document, document each and every conversation/communication you have with your insurance carrier. Be pro-active!!! I sometimes wonder if insurance companies just deny in hopes that you'll give up. My big concern are older folks who don't have the knowledge or stamina to handle the stress involved when an insurance denies your claim or stalls for any number of reasons. And who really knows why they do that but the stress is terrible and certainly doesn't help the patient's recuperation process. (Jill A.)
UMR/Beechstreet - PPO (TN) - 03/26/04
(J. P.)
united - epo (TN) - 03/14/01
Once the Dr. office sent in the paperwork, I got a letter within 3 days saying I my company had written an exclusion on Jan 1st which would not allow obesity surgery. I called the next day and talked to several supervisors. Finally got hold of one (Michelle) who actually knew what she was talking about. I had inquired on Dec. 15th and was told then that if proven medically necessary, it would be covered. Because of this they made an exception. I think I really lucked up...... (ALICIA W.)
united (TN) - 01/05/05
(Todd T.)
United Health Care - PPO (TN) - 07/16/01
I was really impressed with UHC. I had no claims or pre-approval problems at all. A large part of that was due to the fact that my employer supported the surgery so our plan completely covered the costs. (Diana B.)
United Health Care - PPO (TN) - 06/10/01
It was really easy dealing with them. My financial counselor at Centinnal took care of most of it ... I only called them one time to find out the status. (Robin A.)
United health care - ppo (TN) - 05/14/02
They are doing fine thus far. (Lisa B.)
United Health Care - PPO (TN) - 12/01/02
We had a rough start...Pre-approval letter was sent but never received. Sent again but to the wrong number. Finally, I threw a fit and they stumbled upon it...funny how that works. Once the info was there I was approved in about 2 weeks! I would recommend finding out the extention number of your contact person so you can talk to the same person every time you call to check on the status of approval. (Ashley S.)
United Health Care - PPO Saturn (TN) - 08/22/03
All I did was fill out the paper work and the hospital faxed it in on August 2 and got a reply back on August 20th. Two weeks to the day.
I don't think they stalled at all
No.
I have had great approval with this so far.
Since Centennial is out of network it will cost me only $500 for the whole thing.
I did have to pay for my psych evaluation.
I would recommend a recommendation from your family doctor to send to your insurer about getting this surgery. I think that was a great help too.
(Sharon B.)
United Health Care - Saturn (TN) - 08/20/03
I didn't have any trouble at all with United Health Care. They did not request any additional information as they may have enough information from doctors who have treated me for my health conditions. One day, I was telling my husband it could be another month before I heard anything, and checked the mail an hour later, and there it was!! My approval.
I found out on my consult to Dr. Olsen that he is out of network. I paid a $230 consult fee. They will submit it to my insurance company to see if or what they will reimburse. They also will be finding out if there are any out of pocket expenses to be paid prior to surgery. If there are any, we will just pay it. I am not finding another in network doctor now. (Antique A.)
UNITED HEALTH CARE - SELECT EPO (TN) - 11/13/03
(April T.)
united health care - Jesse (TN) - 2004
They left paperwork sitting there, and you will have to stay on them. I had to wait entirely too long. I would recommend! (Stacey O.)
united health care (TN) - 11/13/04
(MELINDA R.)
United Health Care - PPO (TN) - Feb 2007
I was amazed at the quickness of my approval! However, I made sure that my file was full and complete prior to sending it. That meant that I found out exactly what my insurance requires and made sure that I provided that information fully and accurately.
A nurse from the insurance company has called me 2 times. Once pre and once post surgery, just to ask and answer any questions that I may have.
I would definitely recommend this company to anyone. Just be sure to do your homework first. (Sonia B.)
United Health care EPO (AR) - 11/11/02
(Rachelle D.)
United Health Care Saturn (TN) - 01/23/01
(Paula J.)
United Healthcare - Saturn (TN) - 01/24/01
United Healthcare have been excellent! I was surprised that they approved me in 1 week! Plus the nurse that was assigned to my case has been great. She called to let me know I was approved & also took time to answer any questions I had & to give me advice on important things to check with the doctor about. Also she assured me that I could call her with any questions! Even though I don't know her personally she seems like a best friend, helpful, supportive! It made a huge difference & I would recommend this company to anyone! (Diane R.)
United Healthcare - Select EPO (TN) - 07/01/01
Had no problems with United, they were very quick in my case to get it approved, very happy with the outcome so far... (DeAnna S.)
United Healthcare - POS (TN) - 10/28/02
I don't have much to say about them except when my first set of info. was sent to them from the surgeon's office, it evidently sat on someone's desk and got lost. Because after I insisted the surgeon's office call them again, they said they didn't know where everything was and could the office send it all again. Upon re-receiving all the info., I was approved that day. (Dawn F.)
United Healthcare - EPO (TN) - 06/30/02
United Healthcare isn't the easiest to deal with, but then no insurance company is, in my opinion. I didn't have to do anything with them. The Hospital/Doctor's office sent the approval request, and I got the call back from the Doctor's office in about 6 weeks, that I was approved. We then set up my first visit. That was it.
(Jason S.)
United Healthcare - PPO (TN) - 04/15/03
It took 3 very long months and a lot of nagging phone calls from me to get approved. Every time I called it took them forever to locate my request in the system, and I would always get a different answer from the day before. In the end they said they had no record of the request and we would have to start over (this was after 2 months). After I spoke to a manager they actually called the doctor's office and took the information over then phone. It still took a month after that to be approved. (Jeanine S.)
United Healthcare - PPO (TN) - 08/15/2005
(Jamie S.)
United Healthcare (TN) - 09/15/03
(Richard D.)
united healthcare - ppo (TN) - 03/31/04
(Valerie A.)
United Healthcare - PPO (TN) - 04/14/04
my letter was sent off on 4/5 and I was approved on 4/15. I called the insurance company ever other day to check. When I called on the 13th. I talked to a wonderful person and told her how much pain I was in and how hard it was to sleep at night. She put all of this info into my file. She put a rush on it and I was called on the 15th and was approved. I think by talking to her and telling her what I am going through really helped my case. Please call them every other day and make sure you let them know how this is affecting your life. (Tina M.)
United Healthcare (TN) - 05/20/05
(Misty D.)
united healthcare (TN) - 08/08/05
(judy d.)
United Healthcare - Saturn - PPO 3 (TN) - 08/19/02
A United Healthcare nurse called me six working days after I submitted my initial application to Centennial Medical Center. She told me that I had been approved for the procedure!
The nurse explained what I should expect the day of the surgery and after I came home (i.e., what kind of pain medication I would receive, how long I would be in the hospital, the amount of "at home" care I would need, etc). I was really surprised at all the details she gave. She was very well informed and very helpful. (Susan R.)
UNITED HEALTHE CARE - SELECT PLUS POS (TN) - 10/06/04
I had no problems (Pamela C.)
United Heathcare - Select Plus PPO (TN) - 12/30/02
(Kelley D.)
UnitedCare General Motors - PPO (KY) - 09/15/03
The nurses that do the approvals where so helpful I was approved after 1 week. (Shirley J.)
UnitedHealthCare - PPL (TN) - 10/03/01
(Jo Ann H.)
unitedheathcare - saturn (TN) - 04/16/03
(catherine C.)
William C. Beeler / Health Cost Solutions - Ebonite International (KY) - 08/08/03
Our insurance is self-funded and handled by Health Cost Solutions. They used to be William C. Beeler, the name change in early fall of 2003 was to reflect an addition of services which included a surgery precertification division, this happened during my initial request for WLS, after the change was made I was informed that my case was to be transferred to H.C.S. and I would have to reapply for the surgery with them. I immediately assumed that this was another attempt to stall proceedings, but much to my suprise this apparently was a good thing, shortly after H.C.S. received all of my paperwork they approved my surgery. I'm sure some of you know how GOOD that feels! (Brent F.)
Willis Carroon - Signature Health Alliance (TN) - 01/13/01
Willis Caroon was wonderful. After seeing my Dr. he wrote a letter stating it was medically necessary and within two weeks I was approved. I was very persistant and called everyday wanting to know the statis on my claim. I think that may have helped. It was hard being persistant though because of how nice they were. After two calls they knew my name and what I wanted to know. I am very lucky that they were so nice. I was ready for a fight with all the horror stories I had heard but that was never necessary. They were great. (Ann M.)
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