Tri-City Regional Medical Center Bariatric Program

Disclaimer

The information on this web-page is designed to provide a basic understanding of what is involved in a decision whether or not to undergo this type of procedure.

It is not intended to act as a substitute for consultation with a physician but as an introduction to the subject matter and as a basis for discussion. There are many different weight loss procedures currently being performed by doctors at various centers in the Untied States and there are many methods of weight control.

You should discuss with your doctor any questions or concerns you may have regarding weight control before undergoing any treatment.

CLINICAL INFORMATION

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 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 (TX) - 09/11/99
(Cassandra F.)

AETNA - XCLYMO10 (CA) - 12/10/99
IT WAS VERY EASY THEY DID NOT STALL AT ALL YES ONCE YOUR DOCTOR SENDS THE PAPERWORK IN - CALL AFTER ABOUT 10 DAYS AND CHECK IF IT HAS BEEN REVIEWED. IT FORCES THEM TO BRING YOUR FILE TO THE TOP OF THE PAPERWORK AND WORK ON IN. IN MY CASE I HAD 3 TIER LEVEL, HMO, POS AND PPO. THEY APPROVED IT ON THE PPO AND THEN I MADE THEM CHANGE IT TO THE POS. I NOW ONLY HAVE A $500 DEDUCTIBLE AS OPPOSED TO A $4500 OUR OF POCKET WITH MY CO-PAY. ONCE THEY HAVE APPROVED IT ON THE PPO DUE TO MEDICAL NECESSITY, THEY CANNOT SAY THAT IT IS NOT MEDICALLY NECESSARY UNDER HMO (Shanna H.)

Aetna - PPO (CA) - 01/27/00
(Michele D.)

Aetna (WA) - 11/30/00
(Leesa R.)

Aetna - PPO (CA) - 01/11/02
My Dr. sent in the prior authorization request on Jan 11 and I got approval on Jan 14 without any hassle at all! I expected to have to appeal, but glad that didn't happen. (Marcie M.)

Aetna Healthcare - US Access (CA) - 11/8/2000
Aetna didn't stall or waiver in their support of the operation for me. They approved the surgery in less than 30 minutes. I didn't have to deal with them at all as Dr. Fobi's office and Georgia took care of all the details. I would highly recommend that you have a letter from you primary care physician in support of the operation and fully document all the co-morbidities and all the programs you went on to lose weight. It's a lot of paperwork, but necessary and shows your desire to work within the system. Put it down no matter how insignificant or silly you think it. Just like in school...color within the lines and you can get what you want..... (Roger R.)

Aetna Med 300 (WA) - 5/99
(Juley T.)

APWU - PPO (AK) - 01/10/00
It was very difficult dealing with this company and after jumping through all their hoops until I felt like a circus act, they still have refused to pay on the first billing until I call them and remind them that it was preapproved and that they said they would pay, of course they have paid at the lowest % they can. They stalled until they couldn't anymore, I just kept after them and provided all the documentation that they required. I would recommend that you get all your records in order and make copies of everything and keep a log of who you talk to and what they said. (Gwendolyn A.)

Aetna US Healthcare - PPO (CA) - 10/23/00
Aetna has been responsive for the most part. Because the company is large you do need to follow up and check the status of your approval. Aetna did however approve in a reasonable amount of time. (Denise W.)

Blue Cross - Prudent Buyers (CA) - 2-25-00
I did not have to deal with my insurance agency directly. Dr. Fobi's office sent them a letter and less than 1 week later I received a courtesy phone call from Maria at Blues Cross telling me that my surgery has been approved. She said she had already called the doctors office to let them know. After talking to Maria from Blue Cross, David from Dr. Fobi's office called to schedule the pre op tests and the surgery date! (jade l.)

blue cross - PPO (CA) - 8/97
They responded very quickly with me. My doctor sent horrible naked pictures which I am sure helped. I also had a panniculectomy (tummy tuck) approved (Krista f.)

BLUE CROSS (CA) - 02/10/00
IT WAS SO LONG AGO I CAN'T REMEMBER I WAS ALWAYS APPROVED (BETTY G.)

BLUE CROSS - MEDICAL (CA) - 05/31/00
I WANTED TO GET THE SURGERY YEARS AGO, BUT FEARED TO TRY, BECAUSE THE ONLY INSURANCE I HAD WAS MEDICAL. BUT WHEN I RAN ACROSS A LADY'S PROFILE ON THE NET THAT SAID SHE HAD GOTTEN APPROVED AND SHE HAD MEDICAL, I SAW THE LIGHT AT THE END OF THE TUNNEL, SO FOR THOSE OUT THERE WHO HAVE MEDICAL, BUT THINK THEY WON'T COVER IT, THEY WILL. BUT YOU HAVE TO CHECK WHICH PLANS UNDER MEDICAL WILL, AND THEN CHOOSE THAT PLAN, OR CHANGE TO IT. DO ALL YOUR RESEARCH ON DOCTORS FIRST, IT WILL MAKE THE PROCESS MUCH EASIER. (LAURIE H.)

blue cross (CA) - 03/21/01
(A S.)

Blue Cross (CA) - 06/10/03
(Deondrea M.)

Blue Cross (CA) - 03/21/03
(Tenisha W.)

Blue Cross - PPO (CA) - 10/1997
I was approved in less than a week. (Cheryl C.)

Blue Cross and Blue Shield - Gov. Wide (NV)
No Problems with my insurance at all. They went above and beyond, to help me I have nothing but praise for them. THANK YOU (Dr JERROLD S.)

Blue Cross Blue Shield - Personal Choice (PA) - 01/31/00
It was great, Dr. Fobi's office did everything all I had to do was get the blood work and what ever tests they needed. The submitted all the paper work to my Insurance Co. I had an approval in 3 weeks! It's as simple as that I really had little to do with the insurance company they primarily worked with David & Ralph from Dr. Fobi's office. No Stalling none of that with me they where quick and efficient! I would recommend them to anyone who is considering this surgery! (Kim G.)

blue cross cal care (CA) - 12/21/99
(Tonya G.)

Blue Cross of California - Prudent Buyer (CA)
They initially denied me with exclusion for weight loss, but because of being morbidity obese, the surgeon got me approved - however - at only 50% for out of network provider and they paid only pennies - they were worthless. (Linda jean r.)

Blue Cross/ Blue Shield - California Care (CA)
Insurer was great. HMO tried to pull a quickie. If you don't agree with your HMO's decision, then appeal! You just might win!! (Harry h.)

Blue Shield - PPO (CA) - 12/15/99
(Valerie F.)

Blue Shield - PPO shield select (CA) - 09/21/99
Insurance systems are very systematically structure. I was very persistent in checking the process and following up on the timelines that where given to me. I suggest being involved in the whole process from the referring doctor, to the surgeon and definitely the insurance company. (Andrea C.)

Blue Shield - PPO (CA) - 12/05/03
I first was approved for the hospital room in September of 2003. So once I received that letter according to what the letter stated the whole surgery had been approved. I made arrangements with babysitting my husband took a family leave to go with me and I post poned school to have the surgery. Four days before we were leaving for Los Angeles I got a call that the surgery had not yet been approved by the Doctors office. The only reason they found out was because the letter didn't seem right. I then phone Blue Shield and got the run around for an hour just trying to get to speak with a manager. Once I spoke to a manager it took until that Friday the hear anything back and of course the surgery was denied. I am confused as to why it was denied because the insurance company has paid for all my pre-op testing and clinic visits. They have also paid for some of the lab tests after my surgery, while I was in the hospital. Once I got back home I also had another so called approval letter for the hospital room. (Christine A.)

Blue Shield (CAPE) - PPO (CA) - 1/9/01
Let me say, I am not sure about my insurance other than I know they approve very easily, but my sister has Health Net POS and we thought it would be very difficult for her to get an approval since she is also relatively healthy with a BMI just over 44. The paperwork was submitted and it was approved within one day. The best part is, they pay very well for the surgery so my sisters out of pocket expense will probably be less than $2000.00. January 12, 2001 I was approved easily. My doctors office sent the paperwork in on a Friday and on Monday I received my approval call. It was easy!! I have been told that Blue Shield is easy to get an approval with, but they do not pay very well. They only pay around $1,500 for surgeons fees. My surgeon is out of network so I have to come in with $7,000 and my insurance will pay me the $1,500. The most important part is the hospital. If approved the hospital is covered 90%, so I will only have to cover the 10% and most of the time the hospital waives the 10% if you are having trouble. The hospital is where you have the most charges. The anesthesiologist, nurses, meds, bed, respiratory tech, blood work etc all runs up. Most cash pay people have hospital bills around 25 to 30 thousand. SO even if Blue shield does not pay well for the surgeon, it is OK because if you go to an in network hospital, you have most of the costs covered. (Christy B.)

BLUE SHIELD POS - POINT OF SERVICE (CA)
Primary Physician submitted request for approval. It was turned down as being medically unnecessary. I then chose to use the Point of Service plan, which allows me to direct my own medical care, but requires a higher co-payment. Surgery was then approved (JIM W.)

Cigna - PPO (NV) - July 1999
Dealing with Cigna was very easy, Dr. Fobi's office did more of the work than I did. I wrote a letter to my insurance company and sent that along with my forms to fill out to Dr. Fobi's office and they took it from there. About 3-4 weeks later I received an approval letter in the mail from Cigna. I think Cigna believes in the idea of preventative medicine. (Michelle R.)

Cigna - PPO (UT) - 7/01/99
It was really easy. I had a full blood test and physical exam by my doctor. Dr. Fobi's office sent the information to CIGNA. Based on the fact the surgery was deemed "medically necessary" by CIGNA, it was approved within 4 weeks, paid at 100%. (James W.)

Cigna - POS (CA) - 05/01/00
Cigna was pretty good about approving me. I suppose having co-morbidities helped a lot. But, they are very strict on having documented, medically supervised diets and such in your medical history. If you have all your information readily available, I think they are good to approve. (Janet Q.)

Cigna - POS (NV) - 07/18/00
I talked with my insurance company and they told me that it would be covered at 100%. I don't know if they will cover the pann or not. June 16, 2000 Well I am trying to get my surgery approved. They want to know if I have tried any medically supervised diets. Of course the letter that my PCP sent to them states that I have tried Weight Watchers and several other diets but I guess that's not good enough for them. I have been told that I have good insurance but they also required a lot. Dr. Fobi's office does not bill for panns anymore because it wasn't worth it to them. If I want the pann I have to pay cash and try to get the money back from my insurance company. June 26, 2000 I am running around in circles. I think that is there plan so I will get sick of it and quit. I will not quit until I have this surgery. I now have to see a dietician and psychologist. I found a dietician but as far as psychologist I have talked to over 10 and they say that they don't have experience in WLS patients. All I need is a letter stating that I have tried several diets and this is my last options. They also have 2 letters from my Primary Dr. and My OB. I guess that's not enough. I was told by the last psychologist that I should find a Dr. that specializes in patients wanting sex changes. I want to lose weight not go from a female to a male, come on. July 18, 2000 I talked to the insurance company today and I have finally been approved. I was very surprised. I thought I would have to fight longer. (Sheila M.)

Cigna - PPO (CA) - 3/26/01
I had no problems at all. (Janice B.)

Cigna - PPO (CA) - 3/12/04
Cigna has been very courteous. They just keep wanting more records and paperwork. I just resent my 2nd appeal (3/7/04). If they turn down this appeal then they are definitely just stalling. I have heard they respond to persistence from my PCP. If anyone else has Cigna PPO just be sure to have all the paperwork they need. AND.... CALL CALL CALL... call them right away as soon as you know your doctor's office is preparing your approval letter. That way you can find out exactly everything you need. (Naomi S.)

Cigna Healthcare - PPO (CA) - 02/10/00
2-10-2000 Cigna's Customer Service team is inexperienced when it comes to bariatric and/or pre-determination letter's procedures. I was referred to the incorrect department several times. They are also slow when it comes to processing paperwork. They emphasize "Give it more time!" My advice is to...CALL!,.. CALL!...CALL! They will definitely give you the run-around if you are not persistent. Finally I spoke with someone who was instrumental in getting my paperwork moved. It was sitting on someone's desk for four weeks!) I HOPE and PRAY for an approval within a couple of days! 2-11-2000 I called Cigna first thing this morning and the Customer Service Rep. said that I was approved. I was at work so I tried to play it cool.......But I am THRILLED!!!! I'M APPROVED!!!!!!!!!.....I'M APPROVED!!!!!!YEAH!!!!!!!!!!! I am having a vertical gastric bypass with a silastic ring. (AKA) "The Fobi Pouch" (Mackie M.)

First Health Network - Teamsters Miscellaneous Securi (CA) - 08/26/01
I have just started this journey But I will keep you posted I have a stubborn head and I have made up in my mind that I want Dr. Fobi to perform the surgery but now that I have found this website I will start looking for other surgeons. I have never dealt with this insurance company before, I have heard it's the worst PPO plan on the face of the earth if the approve me I will eat those words. I will keep you all informed of my situation. (Martha S.)

First Health - EPP1 (CA) - 01/26/01
First Health was pretty good. Like most insurances the paperwork got lost one time but was found quickly and the sent to the proper people. Overall I rate them very good. (Glenn S.)

GEHA (NV) - 03/03/00
SO FAR, I AM HAPPY WITH THE WAY MY INSURANCE CARRIER HAS HANDLED THIS. I WAS INTERVIEWED OVER THE TELEPHONE BY AN INVESTIGATOR ABOUT WHY I WANTED THIS SURGERY, AND ABOUT MY PRIMARY DOCTORS REASONS FOR WANTING ME TO HAVE THIS TYPE OF SURGERY. I DON'T THINK THEY STALLED ON THIS, AND I FEEL THAT THE LENGTH OF TIME INVOLVED WAS PROBABLY NECESSARY. THIS SURGERY IS DRASTIC, AND EXPENSIVE, SO I THINK THEY TOOK THE TIME THEY NEEDED TO FIND OUT THAT I REALLY WAS A CANDIDATE FOR THIS. (PHYLLIS B.)

General American (OK) - 7/14/99
They were fairly reasonable. Required me to have a Psychological evaluation before they would approve the procedure. (Lesley m.)

Health Net - POS (CA) - 01/04/01
I was very fortunate to have been approved for my surgery after 1 day. They also pay very well, so my portion of the surgery will not cost as much. I do not have any other co-morbidities, so I was concerned that they may not approve it, but they said that I met all their criteria for the surgery and approved me very quickly. (Cassie O.)

HUMANA - EMPLOYERS HEALTH (IL) - 10/04/00
WELL THE DOCTOR'S OFFICE SENT THE PAPERWORK EXACTLY 2 WEEKS TO THE DAY FOR APPROVAL. I TALKED TO THE INS. CO. ON THE FIRST FRIDAY AND THEY TOLD ME THAT THE PERSON WHO WAS WORKING ON MY CASE HAD LEFT THE COMPANY AND THE NEW PERSON WAS VERY BACKED UP AND IT WOULD BE A COUPLE OF WEEKS. I HAD TO CALL THE FOLLOWING MONDAY BECAUSE THE DOCTORS OFFICE SENT ME WHAT THEY FAXED TO THE INS.CO. AND THE WEIGHT SAID 230 NOT 320 AND THAT'S A DIFFERENCE OF 90LBS SO I CALL THE INS CO. FIRST (BECAUSE I THING THAT WOULD BE A BIG THING IN JUDGMENT) TO FIX IT AND THE DOCTORS OFFICE CALLED ME 2 DAYS LATER. I WAS SOOOOO SURPRISED! (JENNIFER J.)

Humana - PPO (NV) - 3/6/02
The first request that sent to Humana PPO - was "not legible" according to the pre-cert department. Be prepared to play games. Also, Humana will not approve WLS unless you "prove" to them via old records that you have been morbidly obese for 3+ years. Be ready to contact old doctors, programs, whatever you need to to get old medical/weight loss records. If you do this first, it will save you valuable time! (Michele .)

Mail Handlers - PPO (NV) - 05/10/01
I had no problem with Mail Handlers. I called them on a Monday morning and was told the surgery request had been phoned in by Dr. Fobi's office that previous Friday and approval was authorized right there over the phone that same afternoon. (darcee v.)

Medi-cal (CA) - 04/16/01
(Jennifer H.)

Medi-Cal (CA) - 04/29/02
Medi-Cal is not bad-- It's really the doctor's office that will be dealing with them. Make sure your doctor submits EVERYTHING that the state requires. I was very fortunate to be approved so quickly. I don't think there is any way to check the approval status thru the state, so you just have to play the "waiting game." BUT DO NOT GIVE UP HOPE!! I didn't think it would be easy, but it was!! (JODI M.)

Medi-Cal (CA) - 03/24/03
(Bonnie Y.)

medical (SSI DISABLED) (CA) - 10/18/00
(Alfred p.)

Medicare - Medicare (CA)
This is just straight Medicare for people on Social Security. (Jennifer S.)

MEDICARE (CA) - 12/26/00
(HAROLD E.)

Medicare (NV) - 02/05/02
I never spoke to them or ever mailed them. (Jeremy B.)

MEDICARE - MEDICAL (CA) - 06/22/03
I had no problems, when I presented my Medi/Medi to Echanna she told me I was approved, and that all I had to do was get my pre-ops, approval from the doctors to see if medically I could stand the procedure and then I would be given a date. (La Tonnia S.)

Medicare in NC - Medicare A and B (NC) - 08/18/01
Dealing with NC Medicare is a nightmare. A person could have 10 comorbidities and still need to provide more information. Thy stall like crazy and it takes committed persistence to get anywhere with them. They are mostly unresponsive and don't give a royal damn. They would rather pay millions in hospital bills than help a person have surgery. If you have to deal with Medicare make sure everything you have ever tried is documented, include all the doctors you see, all the medications you take, and pictures of you front back and side views naked. That has been known to get their attention. (Wanda E.)

Medicare&Medicaid (MI) - 12/09/02
(Hally Sue N.)

Medicare/Medi-cal (CA) - 02/15/00
(Jo M.)

none (AK) - 09/18/99
I don't have one. (Linda r.)

none (NM) - 03/12/00
(Jean P.)

NYL Care (Alaska Care) (AK) - 10/15/99
Great response. Very helpful. Doctor Fobi sent to Insurance in CA 5/7. Case Manager sent to Ethics Review 5/12. Approved 5/14. (Lynda B.)

Pacific Care - HC Partners PPO (CA) - 01/27/03
(Nate W.)

PacifiCare of Oregon (OR) - 05/10/2000
This company is only interested in money. Prior to my request for WLS, I was denied a scooter, and it took them 13 months to then get me a pair of crutches. I had fought with them numerous times over medications, durable medical equipment, compression garments, etc. I knew it would be impossible to get them to provide WLS. So I paid cash for my WLS, and went to them after the fact to attempt reimbursement. Of course, they claimed that I was "obviously an excellent candidate for WLS" and they "would have approved me, if only I had come to [them] first". Yeah, right. I did not win this battle with them. I haven't heard of anyone getting WLS through them, even though they claim to cover it. More and more insurance providers in Oregon are making WLS an exclusion. A group of us are working on the legislature to make it illegal for them to deny WLS or to make it an exclusion. (Gigi G.)

Principal (AK) - 05/18/01
(Andrea C.)

PRINCIPLE (MO) - 08/23/00
THEY APPROVED MY SURGERY BEFORE I HAD THE SURGERY. NOW TWO YEARS LATER THEY ARE TRYING TO GET OUT OF PAYING. THEY ARE DIFFICULT TO GET ALONG WITH AND I NEED TO TAPE ALL PHONE CONVERSATIONS BECAUSE THEY DON'T ALWAYS TELL THE TRUTH, HOWEVER, WITHOUT THEM I NEVER WOULD HAVE BEEN ABLE TO HAVE THE SURGERY, AND THE SURGERY CHANGED MY LIFE, HECK IT MIGHT HAVE SAVED MY LIFE!!! (SANDRA DAWN W.)

Prudential - pos (OK) - 02/22/00
I really didn't deal with prudential. I filled out lengthy forms and spoke with one of the surgeons over the phone and they compiled a very good letter with factual information and their impressions and recommendations and faxed it to the insurance co. I received an approval letter with out of network benefits which I pay 20% and they sent a dollar amount of how much they would pay. I have not had any problems as of yet. Yes, I would recommend them. (Raunna G.)

Prudential - PPO (CA) - 02/01/00
They were great. With two weeks I don't believe they stalled at all. I would recommend them to anybody. (Glenn B.)

Prudential Healthcare - Triple Option Plan K (CA) - 11/20/99
They will tell you 70 percent coverage, but will offer 40 percent after all is said and done. They respond to persistence in regarding to claims. Be very accurate and on top of things when you deal with Prudential. Always take down the name of the person you are dealing with, and get things in writing! (Catherine R.)

Prudential PPO - PruCare (CA) - 06/03/98
I had absolutely no problem getting approval for my surgery! After an initial denial, they also approved my panniculectomy (apron removal) at the same surgery! (Rebecca R.)

self-insured, Professional Benefits Administrators (NV) - 8/20/99
(Susie G.)

State of Ak. Aetna (AK) - 01/22/00
My approval was fast and I was very pleased that they approved the removal of the fat apron, this procedure is called a Panniculectomy (major tummy tuck). They also covered airfare but it must be preapproved. State of Alaska employees have a very easy time getting this surgery approved if it is warranted and you have complications that can be documented by your physician. Doctor Jennifer Bzowy at Dr. Comptons office is very familiar with getting the approvals through and doing all the post op testing. (Cynthia H.)

State of California (NV) - 04/01/00
(Darren P.)

Teamsters Benefit Trust - Local 150 (CA) - 05/15/01
They are very pleasant. No resistance at all. They only asked for a psychological evaluation and recommendation from my doctor. Before the week was ended THEY called Dr. Fobi's office asking how things were progressing and when could they expect their answers. The info was faxed to the insurance company and they approved within two days of receipt. (Sharon S.)

Tri-care standard - Medical for Navy (CA) - 08/12/01
Dr. Fobi's office took care of contacting insured. After my office visit w/them I filled out all paperwork, they examined me. After seeing a Dr. at Tri-City Regional Medical Office, Hawaiian Gardens, they wrote a letter to my insurance co. It took only 8 days for approval. I didn't think I would even pass, or be approved because at the time my BMI was only 38.67 and I had heard that they like to see a BMI of 40 or more. So, while I was waiting for approval I put on 10 more pounds, because I thought I'd have to fight them about it. I was approved anyway. (Beth N.)

TriCare Prime (CA) - 01/26/00
Military insurance company. (Dody R.)

united health care (TX) - 03/18/04
They were great to deal with. (Chere b.)

United Health care - options (NV) - 02/06/02
They were very nice. My doctors office sent in for the approval and a week later a nurse called me and said I was approved and wanted to make sure I understood the surgery and that the doctor explained in in detail to me. (Yvonne C.)

United Healthcare - PPO (TX) - 10/26/99
Dr Fobi's office did all this work and I was a pproved the first time I applied my insurance covered all but about $1000.00. (William C.)

United HealthCare - POS (CA) - 08/22/02
My PCP would not refer me to Dr. Fobi - instead she wanted me to go to a year of Lindora, or some other one-on-one type place first. I just shook my head and said losing weight isn't the problem - I've lost hundreds of pounds over my 40+ years - keeping it off is the issue here and I wanted a tool that would assist me in my goals. Since I did not have a referral, and I am going out of network, I will have to pay more for the tests (LOTS of pre-op tests!) surgery and after care. To cover my expenses I've cashed in my retirement. Oh well, is it better to save it and die young or spend it and hopefully have many more years to spend with my adorable husband and my beautiful, talented, teenage daughter??? I opted for spending time with the ones I love. I'm paying the penalties for early withdrawal --- well worth it in my book! (Mary T.)

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