My ?Insurance co. Doesn't cover bariatric surgery! Any suggestions?

Levan2k
on 11/20/15 9:16 pm - Greenville , SC

My insurance co doesn't cover bariatric surgery! My resources are limited! Any suggestions? Should I try disability.? Any organizations that  help?

 

Sharon SW-267
GW-165 CW-167 S.

on 11/21/15 7:23 am - PA
RNY on 12/22/14

This is now open season to change ins plans.  Have you looked for one that does??

Sharon

kathkeb
on 11/21/15 9:02 am

Second job that does cover WLS

loans

family financial support

saving

Do you qualify for disability?  If so, then definitely research your options there.

many of us here were self-pay.  We saved, borrowed and sacrificed until we could afford to do it.

 

Kath

  
(deactivated member)
on 11/21/15 11:26 am - CA

If your insurance excludes bariatric surgery, it's very difficult to get past that.  The only other option is that if you have multiple plans to choose from at your work, find out if any do include it and change to that plan.  It is Open Emrollment time for most employers so I would start checking into it.  If your open enrollment has passed, you would need to wait until next year. 

 

Alternative options:

Personal loan to cover surgery. 

If you have a 401k and are fully vested and open to cashing it out, you could use that. 

I hope this is somewhat helpful.  I personally know how frustrating this obstacle can be. 

Nik

Laura in Texas
on 11/21/15 11:39 am

You have received good advice here. Where there is a will, there is a way, but you need to do the work. Expecting someone else to do it for you will not work. Make a plan and follow up with all of your options.

Laura in Texas

53 years old; 5'7" tall; HW: 339 (BMI=53); GW: 140 CW: 170 (BMI=27)

RNY: 09-17-08 Dr. Garth Davis

brachioplasty: 12-18-09 Dr. Wainwright; lbl/bl: 06-28-11 Dr. LoMonaco

"May your choices reflect your hopes and not your fears."

(deactivated member)
on 11/21/15 4:39 pm

My insurance didn't cover WLS either. I went to Mexico and was self pay. There are hospitals there  every bit as good as in the US or even better. You can get weight loss surgery for $4,000 and up. They can even arrange financing for you. Other than getting disability and then waiting for Medicare to kick in if you can't change your ins carrier I really can't think of any other options. Never heard of any organizations that would help but that does not mean they aren't out there. Sorry this is so hard for you.

(deactivated member)
on 11/21/15 6:38 pm
RNY on 05/04/15

The above posters offered some great advice. I don't know of any organizations that help as many find themselves in this same position. It's the right time of year to look for other insurance options though. Time to start hunting around for plans from your state exchange that cover it!

I originally planned for WLS in 2012 and was going to be self-pay because my insurance had the same exclusion. Some health issues derailed the plan, but by then I'd finished grad school and was job hunting anyway. The job hunt took 11 months, then after I moved 2400 miles and got a job with insurance that did cover it, I found out they had a 2-year waiting period before being eligible for WLS (in addition to the 6-month weight management period). In the end my surgery was more than 3 years after my originally scheduled date, but I'm just glad it finally happened at all. When there's a will, there's a way; it might just take a lot of work, creativity, and patience. Good luck!!

(deactivated member)
on 11/22/15 4:32 am

When you are browsing plans on the Healthcare.gov site, you can see the details for each plan to see if they cover WLS.  Many of them do.  They would rather pay for this than for all your health problems that would occur because you didn't do it/follow through.  Check them out because you can get a subsidy to help pay for the insurance.  I'd go that route.  Good luck!

sncedarcreek
on 11/22/15 4:42 pm

I just switched my insurance carrier because on the government website it stated it DID cover bariatric surgery if it was 'medically necessary'. I was thrilled to be able to get insurance that would until I got the actual paper policy and it very plainly states in there under exclusions: bariatric surgery. It also says any treatment for obesity whether necessary or not.

So now what? I am going to see if I can switch again while the there is time. So don't take what you read on the website as gospel!

Starlene02
on 11/22/15 7:11 pm, edited 11/22/15 11:11 am
VSG on 11/11/15

Every once in a while you can get your surgery covered despite it not being in your plan but it's very hard to do. You'd need to first extensively prove that it's needed. It's best to have a surgeon in mind and a lot of times there is an office that will assist you with insurance through that surgeon. You'd need to complete 6 months of medical monitored weight loss as well as have comorbidities that can be proven and backed by medical records such as high blood pressure, sleep apnea, high cholesterol, bad knees... It would also help to have several doctors writer you a letter of support explaining why they feel like the surgery is necessary as well as write your own letter explaining why you feel they should pay for it. After all of this you'd need to file a letter of appeals with your insurance. Again though, it isn't an easy task and insurances are very stubborn. If it isn't already in your plan, chances are they will not side with you.

If you feel like quitting, think of why you started.



 

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