Insurance Denial for RNY

I just found out today after being denied that apparently within a 161 page online booklet of what is covered on my insurance there is an exclusion of any WLS! I'm very upset but I guess I'm the dumbass for not knowing! I'm trying to figure out how I can get my insurance co. to cover my surgery. Has anyone been successful in getting your insurance co. get your surgery civered when there is an exclusion to WLS??

Any advice would be greatly appreciated.

they won't cover it period. Having an exclusion means your employer didn't buy the coverage for bariatrics for their employees.

The ins co is not going to pay for something that they have not been paid to cover.

the only way they would is if your employer should decide to buy the coverage.

otherwise,you are looking at self pay. Sorry to be the bearer of bad news.

Unfortunately it's not possible to get around a WLS exclusion. If they don't cover it, they just don't cover it. That's the same boat I was in when I was planning surgery in 2012. I wound up planning self-pay, but surgery got delayed due to other health issues, so I waited a few more years until I qualified through new insurance at a new job. Good luck with whichever path you head down next!

Oh no, I'm so sorry to hear that! Is there anyway that you can manage a self pay? What a huge let down after all the planning and work you've put in.

Don't let this derail you. Stick to what you've been doing until you explore all the other options available to you.

So very sorry! I was kinda in the same boat. My husband's insurance (which was primary) had a rider that excluded all obesity treatments, complications and surgeries. Luckily, I had insurance coverage (which was secondary) that did pick up everything. If there is an exclusion there is no getting around it unless you have a partner who's coverage includes WLS. Don't give up on your journey.

I can imagine how disappointed that you are. Have you given any consideration to having the surgery done in Mexico? Don't give up hope. Where God shuts a door he opens a window somewhere.

WLS prices seem to vary widely in the United States; mine was around $25K in 2012. A local woman flew to Mexico and said she paid well under $10K, but that was many years ago. Maybe others will post their approximate WLS cost, too.

BeLitWeight quoted $4500 plus air fare for 2 for VSG back in March of this year. I was saving up until I found that I have coverage.

I remember checking my insurance and seeing it was excluded, but then the new plan year came around and when I checked it was no longer excluded. I believe WLS is gaining acceptance and hopefully coverage is expanding. I don't know how your insurance is set up, but if it is through your work, maybe you can talk to someone about adding coverage for the new plan year. Losing the weight will make you a more productive employee, so it is in their best interest.

Thank you for all of your help and advice everyone. I really appreciate it!

I will continue to try to get this all worked out and never giving up!