Insurance... curious?

Hi guys!!! How is everyone? Well I have been a member for quite some time. I have been trying to have WLS for some time now. I was going to self pay since I didn't have insurance to cover surgery. The thing I am curious about is when you start a new job and your insurance covers the surgery how long must someone wait before they can see if they will get approved? Is there a time limit or can I apply once the insurance kicks in? Any advice would be greatly appreciated. Thanks

My guess is that you can apply immediately unless there is a wait clause for pre-existing conditions.  By the way, I am near you, in Central Louisiana!

Thanks so much. I am going to give them a call to find out. What part of LA are you from? Monroe here. Where did you have your surgery if you don't mind me asking?

I live in Pineville, but I have not had my surgery yet.  It is scheduled for 11/20, so I am counting down.  I had to go to Dallas because nobody here would take my insurance.  My primary which is BCBS of LA does not cover the surgery, so I had to fall back on my secondary which is ChampVA.  Unfortunately , I couldn't find a doctor here.  But I did find an excellent doctor in Dallas.

 

Where I work, you must work for the company for over a year before insurance will pay for it.  Provided you pass all the insurance requirements.  Mine are listed below.  Funny too how I wanted the DS or the RNY- Medial type but my insurance said my BMI was not high enough.  So I got the RYN Proximal. 

 

2 yr weight history from dr.'s chart notes.  They also took my WW card and made a copy.

Confirm you have tried to lose weight.   WW, medifast, on your own, pills etc....

See a nut for min. of 3 visits.

See your dr. for a min. of 4 months while under a weight lose and exercise plan

My dr. gave me goal of losing 10% of weight.

Approval from a pych to make sure you are not doing this for another person and know what you are getting yourself into.

Bunch of lab test 

 

 

You'll need to call your insurance company and get the specifics for your policy. I'm also going to suggest that you re-think your decision to have the RNY---given your BMI, the DS would give you a better chance of achieving and MAINTAINING a normal BMI long-term. The DS has the very best long-term stats for patients of any size, but especially so for those of us with a BMI greater than 50.

 

If you choose to go the self-pay route, look into Drs. Ungson and Aceves in Mexico. You can have the DS, complete with a two-week stay in their hospice, for around $16K.

My employer's plan says that they will not cover bariatric surgery unless you've been an employee under the insurance program continuously for 5 years.  Luckily, by the time they finally added it (about 2 years ago), I had already been an employee for 5 years.  Then they wanted me to do a full one year medically supervised diet.  So, I waited on my surgery for quite a long time.  I'm now 6 days post-op!  Waiting was well worth not having to pay out of pocket, for me at least, because otherwise I'd never be able to afford it!