WLS Specifically Excluded - Self-Pay Options

Many insurance companies have policies that cover WLS, however, whether or not that coverage is available to you as an employee (or dependent of the 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, WA 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 self-pay patients:

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.  The Lap band required frequent adjustments that cost atound $200.00 each.

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 everyone much luck in their quests,

Amy

Hi Amy-
You've certainly summarized very well the problems that many patients like yourself are having with getting access to weight loss surgery through their employer and their insurance company.  I've been in the industry for several years now and have personally coached patients through these barriers.

Unfortunately, there are many companies out there like the one your described in Redmond, WA that choose not to add the bariatric rider because of cost of the premiums and because of the financial risk of complications. My company has been successful in  helping companies provide access to weight loss surgery for their employees. We provide a network of surgeons through a cash-pay model that will perform weight loss surgery with complication protection included in their price. This model has proven much more cost effective for the employer and takes the financial risk of being a self-pay patient out of the decision making process. If you or anyone else would like to learn more about how your employer can participate in this network, please contact me directly or visit www.bliscompany.com

Also, please let me know if there is anything additional information I can provide. Best wishes to everyone in their weight loss surgery journey!

Billie

Thank you so much for the information.  I will check it out and perhaps write another letter to DH's HR department.

Amy 

Good Amy! I'd be happy to provide you with some documentation about the programs we set up or to contact the HR department myself if you'd like me to. Let me know & good luck! Billie