I was wondering if anyone has BC/BS of Florida.  The gastric bypass surgery is excluded and now I am trying to appeal it.  I am asking to see if anyone has done this with this insurance company?  I have many doctors that I have seen within the past year that state I need to lose weight and they will not be able to help me with my back, knee, thyroid, or neck problems.  This is my last option. I have been dieting since 1995 and nothing has worked.   I would like to have some insight as to how to have the insurance company take care of my gastric bypass as I am unable to pay for it as a self pay person.  I am a teacher and a mother and if I do not do this, I will end up in a wheel chair within 5-10 years.  I am very young, please help.  Thank you for your guidance. 

I've asked similar questions before and not got much of a response, so going to try to be a little more clear this time in hopes others have similar experiences and could share their stories. 

I have BCBS of Michigan. I am covered under my employer and I have  50% co-insurance coverage. My out of pocket co-insurance maximum should be $3000 according to my plan documents. My out of pocket max for healthcare period should be $6,600, this includes my co-insurance payments according to my plan documents.

I have done my psych eval, surgical consult, etc. and the hospital should be submitting for approval for the procedure this upcoming week. However, the lady who is in charge of getting approval for the surgery made a comment about how co-insurance and out of pocket maximums don't usually apply to bariatric surgery and that I would likely be spending $15,000-$20,0000 out of pocket in order to have the procedure. She couldn't give details because she wasn't from the financial department, but she told me that I'd be in touch with someone from financial to figure out what costs I'd be responsible for once she gets me approved for the surgery. 

I was heartbroken and have been in a bad mood ever since. I'm sick with worry, fear, anxiety, etc. I want and need this surgery more than I'd been willing to admit until recently. I was every bit prepared to pay $6000 - $7000 out of pocket. It's a small price to pay. Just wondering if others had co-insurance amounts they had to pay and if bariatrics were included or excluded. Thanks in advance!

I live in Brevard County, Florida and have Staywell Insurance through Medicaid. I am hoping to get the gastric band. Not quite sure yet. Are there any surgeons in my State that accepts Staywell? Thanks a bunch!

I have not actually heard anything back about it, The surgeon that I am working with was telling me that coventry really did not give them much information as requirements that they have other than medical necessity. I did talk to coventry and checked my summary of benefits and it was listed as a covered service the only thing that they did not cover was weight loss programs or medications.

Hey Sabyan2060, I have Medicare too and my coinsurance with Cigna Healthsprings is only $2.40 a month with extrahelp from medicare. I have full insurance with a small deductible. Check into some coinsurance or part C (medicare advantage) insurance. It will save you money!