Insurance HELP!
So I've recently been looking into getting gastric bypass surgery. My first concern is insurance. Calling around to the major insurance companies I keep getting shot down with, "Oh no ma'am. we don't cover ANY type of bariatric surgeries." I was wondering if anyone knew of any companies that would, under certain policies, cover gastric bypass surgery 100%?
I think there are quite a few companies that do cover it. Depending on which plan you have, you'll likely have to pay at least some copays. I have Federal BCBS and the coverage is good. I had to meet their requirements (2 years consecutive history of obesity, BMI 41 or over, 3 months physician supervised diet/exercise program). I was approved on the first go and just had to pay the normal hospital and surgeon copays on my plan. Are you looking at group plans though work or would this be an individual plan? The coverage for those may be quite different, but I'm sure others here can speak to those type of plans.
RNY: 1/14/16 Age: 34 Height: 5'4" SW: 280
If you are looking for an individual policy, BCBS is probably the best choice, but probably will not cover it at 100%, at least up front. You would have to meet your maximum out of pocket. Another option is Obamacare. Plans through the marketplace cover bariatric surgery, but only in certain states. The states that it does cover it in are below.
- Arizona
- California
- Delaware
- Hawaii
- Illinois
- Iowa
- Maine
- Maryland
- Massachusetts
- Michigan
- Nevada
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Oklahoma
- Rhode Island
- South Dakota
- Vermont
- West Virginia
- Wyoming
From what I understand, the state decides what is covered. Check to see if you live in a bariatric covered state or in a bariatric not covered state.
I applaud your efforts to find something that works for you.
But I would not bother calling around to insurance companies. I would find a surgeon's office that does a bunch of WLS surgeries and start by asking there. Each office that does a significant amount of WLS surgeries will have an insurance specialist that ALREADY knows more than YOU WILL EVER KNOW.
WLS takes 100 surgeries for a surgeon to get good with them - find someone who does WLS for the major part of their surgical practice.
Sharon