Introductory/Insurance/Inquiry Post

Hello Everyone,

I thought I'd take an opportunity to stop lurking and introduce myself.  I, like many, have battled with obesity throughout my childhood, into adolescence, and on into adulthood.  Diets, diets, diets with marginal weight loss only to regain all that was lost plus extra.

I've only recently come to terms that weight loss surgery may be one of my last options.  Having done hours of research I have come to the conclusion that the duodenal switch would likely be the best surgery for me.  As I come to this realization I learn that I'm very close (geographically) to a talented surgeon who performs the duodenal switch surgery regularly.  I thought my luck couldn't get much better!  I started attending support groups at first and becoming much more comfortable with my decision to go forward with surgery.  I was ready to make my appointment with the surgeon.  Just to be sure I call my insurance company to make sure it's covered - must be, right?  And in one phone call..."I'm sorry but your policy does not cover any weight loss surgery.  Is there anything else I may assist you with today?"  The wind was out of my sail.

I've read several posts on OH regarding the "WLS rider" that is employer dependent.  I think with my insurance company's statement it is obvious my employer did not include the rider.  The interesting part comes next:  My company is switching insurance companies in October because with our current policy the insurance company paid more out than they made from our premiums.  That being the case I can't imagine they would include a WLS rider when they currently don't.

My questions:
1.  Assuming that the new insurance company does cover WLS but my company doesn't opt for the rider. Is there a way that I can approach the insurance company to see if I can personally pay for the rider so that my employer doesn't need to pay for it for every employee?
2.  If the rider is not included this means that the insurance company will not pay for the surgery even if it is declared medically necessary, right? 
3.  Are the supplemental insurance options to fund WLS?  I've scoured the net but have come up short.

I apologize for the length of this but thank you all for any help you have to offer!!  

1.  Assuming that the new insurance company does cover WLS but my company doesn't opt for the rider. Is there a way that I can approach the insurance company to see if I can personally pay for the rider so that my employer doesn't need to pay for it for every employee?  NO

2.  If the rider is not included this means that the insurance company will not pay for the surgery even if it is declared medically necessary, right? YES

3.  Are the supplemental insurance options to fund WLS?  I've scoured the net but have come up short.  NOT THAT I'VE EVER HEARD OF

First of all, you need to obtain a copy of your entire insurance coverage contract document so you can review it yourself.  Get it from your HR department.  NOT the summary, the whole thing.

Second, you might have better luck, depending on the size of the company, to ask them to INCLUDE bariatric coverage in the next year's plan as being a long-term investment in your health.

Third, you might have to consider changing jobs to one with better coverage.  You could tell your HR department that inadequate insurance coverage is one reason you would consider doing it (thought I would make sure you had another job lined up before you tell them that).

 Thank you for your reply.  We won't find out who our new insurance is through until the beginning of September.  And they said they would have "meetings" for open enrollment information.  I'm not sure if these meetings will be given by our HR manager or from the insurance company.  But I will definitely ask for the coverage contract. Changing jobs isn't an option for me at this point.

Thanks for your help!  And thanks for the welcome Gina.  It's been 4 years of thinking and struggling with the idea of having surgery to help against obesity. 

Welcome out of lurkdom. You've made a huge step in just making the decision to pursue WLS and the DS. Wishing you all the best in your journey.

--gina
 

Welcome. I totally understand the insurance frustrations

Good luck on your journey.

 Thank you Gail.  It's quite frustrating and a mighty let down.  I'm going to do what I can to see if I can gain coverage.  If all else fails I suppose I'll start saving my pennies for the ~$35K price tag for self pay patients! 

You can do it self-pay for a lot less than Dr Smith would charge you.  Check out Stewart and Ungson.

~Becky

You can travel and get a DS for a fraction of that cost. Dr. David Greenbaum in Willingboro, NJ has just begun offering a self pay package that sounds like it's going to be an excellent deal, well under $20K and perhaps even less. Contact him through his website www.drthin.com or www.duodenalswitchdoc.com .

I was on track for a RNY to RNY revision when I found that my insurance did not cover WLS. Guess it was a blessing in disguise since it eventually led me to the DS.

Just so you know, there are a few self pay options less than $35,000.

Dr. Daryl Stewart in Denton TX comes to mind. It would involve travel, but many of of have to do that.

 Thanks very much for the info.  I'll start researching Ungston and Stewart.  I've read good things about Dr. Gagner in Quebec.  I'm not sure about his cost.