Insurance for Gastric Bypass

Uniform Medical Plan (state employee coverage).

Alicia

Unfourtunatly I am not a state employee.

I am self employed with my own business.  I am the only employee.

Might want to look at the VSG. It is about the same price as the lap band, but does not require any post op fills or adjustments. The vitamin regime is cheaper too because there is no malabsorption, just lifelong low calories. Don't believe the old studies saying only 30-60%EBW lost. The newer protocols call for a much smaller tummy and have better weight loss.

If you look at package deals for surgery, be very careful what is included. For example, Dr. Aceves and Dr. Alvarez in Mexico do an excellent job and their package includes everything but the airfair.

Dr. Srikanth's package sounds like it is only $1,200 or so more. But Srikanth wants every lab ever recommended, and a bunch of tests and consults pre-op. It would cost quite a bit over the package quote if you didn't have insurance to cover the studies.

Best of luck!

An earlier post indicated Aetna covered WLS.  It is true that Aetna has policies that cover WLS, however as some have stated, whether or not that coverage is available to you as an employee of Company ABC is completely dependent on whether or not Company ABS chooses to include that rider in the package they selected for their employees.  I have Aetna Open Access Select through my husband's employer.  His employer, which is a well know world-wide operation whose North American Headquarters are in Redmond, offers an excellent benefits package...but all weight loss surgery regardless of BMI, co-morbidities, etc is specifically excluded because the employer chose not to include it due to cost.  We have written a letter to his HR Department but it s unlikely that coverage will be added due to the premiums associated with the WLS insurance rider.

Also keep in mind that many policies that do cover WLS require all covered individuals to jump through numerous hoops before approval is granted regardless of co-morbidities, BMI, etc.  It is not uncommon for individuals to have to be on a medically supervised weight loss program for between 6-12 months before eligibility.  Once eligible, there are numerous people who have still had to battle the behemoth corporate insurance companies to get approval.

There are alternatives available to going through an insurer for weight loss surgery: 

Many surgeons offer a "low" cost self-pay package, but one must be aware that the cost of such packages does not typically include pre-op labs/exams/consults nor follow-up care beyond 30-90 days.  Depending on the surgery chosen and the surgical risks of the patient, those costs can be quite expensive and may or may not be covered by any medical insurance carried by the patient.  For example, I am getting the sleeve (VSG) on 11/19 and my surgeon, given my medical history and BMI, ordered 24 labs, 8 tests (ultrasounds, stress test, etc), and 4 consults.  My insurance should cover all of those but I am preparing to battle if denied.  Follow-up care required for gastric bypass could be expensive due to the need to constantly monitor labs due to the malabsorbtive nature of the procedure.

Medical loans / financing are available.  The interest rate is appalling but if it's the only option, it's nice to know it's available.  One company that offers such loans is http://mymedicalloan.com/ .  You may also be able to secure a loan through your bank depending on your credit history. 

And finally, Mexico is a lower cost alternative to local surgeons.  However, there is no follow-up with the surgeon once you leave Mexico.  Depending on the type of surgery chosen, the cost of follow-up back in the States could be quite expensive.  This option also requires that one be comfortable with having a major medical procedure outside of the US and not having an opportunity to meet face-to-face with your surgeon until literally just days before surgery.  I think t is possible to get very good medical treatment in Mexico, however, given the lack of access to the surgeon and follow-up, I would be very careful when selecting a surgeon. 

I wish you much luck in your quest,

Amy

Thank you Amy, your input was valuable.  My insurance through Regence does not cover WSL but my family physician still wants to give it a shot and see how they respond.  He says it won't hurt to at least try.

You're welcome - Amy

plans vary and since you are self employed, you should just ask while you are insurance shopping, it shouldnt be some great big secret? Call annonomously to each and see. At work we have BCBS of Illinois and its covered BUT only after 12 months of physcian supervised diet (means seeing your PCP and a dietican every single month for 12, if you miss 1 month, you start over...but at tleast its covered).