What insurance do I get? I am about to buy insurance and need WLS

I don't know where you live but not only did I have the gastric sleeve but I have been in the medical field for 25 years. I have Horizon Blue cross Silver with tier 1 and 2. There was no problem getting approved. A Dr friend of mine has Oxford and they would not cover the Sx. I'm in New Jersey, I hope it helps.

Everyone here has given you good information about coverage varying from plan to plan. What I didn 't see was an answer to your technical question.

Maximum Out of Pocket Expense means that, $2500 is the most you will spend out of pocket for covered medical services in a year. They add up all of the copayment and co-insurance you pay, and when it reaches $2500, you don't pay any more out of pocket for the rest of the year.

For example, let's say you have a covered surgery on January 2nd. The surgery costs $40,000, and your policy has a coinsurance of 20% (that's the amount you pay). Because your max out of pocket is $2500, you only pay $2500 instead of $4000.

A deductible is an amount of money that you pay for covered services in a coverage year before your insurance company pays anything. It generally does not get counted towards your max out of pocket amount. In the above example, if your policy also has a $500 deductible, that would mean that you would owe $3000 for the surgery.

This is a very simplified example, and isn't always as clear cut as this. For example, essential health benefits as defined under the ACA are covered at no copay or coinsurance, and are not subject to the deductible (no cost to you no matter what your deductible is).

Also, non-covered medical services are not counted towards the deductible or max out of pocket. So, if bariatric surgery is not covered under your policy, you are on the hook for the full cost.

Good luck on your journey.

Kaiser is really good they have a 12week program you have to complete prior to surgery. Most insurance does require some type of pre-surgical program. I have United Healthcare. If your Doctor puts in a Preventative Care referral (More than 1 problem BMI OVER 40, High Blood Pressure, High Cholesterol, etc) than you can do preventative referral.