Have 2 insurances but neither cover WLS at all/private pay?

Hi Cheryl, We'd love for you to join us on the Over Fifty Forum. ON the main OH page under forums scroll down til you see "more forums" click. . . that will take you to a whole page. Look for Weight loss related heading. Under that you should find over 50 forum. There is also a over 50 BMI forum. . . HOpe you find us.

Hi - i was self pay also with insurance that wouldn't cover it.  i didn't make a run at it because i did not have the many comorbidities...so thought I would probably lose.  I had it done at Northwest Hospital in Seattle.  he total was $15,900.  $10K for hospital - 4K to surgeon Dr. Joseph Chebli - and the remainder was for anethesitiologist/nutritionist and the like.  I had my done 6/18.  I am very satisfied.  I decided to do this for myself because i was so afraid of getting diabetes...and my blood pressure was climbing.... sleep apnea, etc.  The good news is that my insurance did cover all of the medical tests pre-op.....I think they are labeled Diagnostic or something like that. Carlotta

I think my insurance will pay for some of the pre-op stuff. It didn't pay for a big chunk of the mental eval testing, but for some of it. Thanks for the info, I am thinking along the lines you are. Cheryl

I also have a written exclusion policy.  I am self employed and have to privatley purchase my insurance.  I am unable to purchase a private pay policy that covers WLS because one does not exist in WA. Unfortunatley, being self employed means I am pretty poor at this point in my life.  I have wondered if maybe I could somehow qualify for medicaid through DSHS and get the surgery that way. Has anyone tried that option?  Can you get medicaid to cover a problem that is excluded by your private insurance?

My understanding is that Medicaid may cover, but you have to not only qualify financially, but also be eligible and have certain conditions just as most insurances require that do cover the surgery. Good luck in whatever you try. Cheryl

I looked at the law online.  I have he requisite co-morbidities, no problem there.  Last year my family of 3 had an income of just over 20K so I think we might qualify for the financial side...

I ordered the packet from Rockwood clinic - I cant wait for it to arrive.  they have information meetings so I will go to one of those and find out if I need to apply for DSHS first, or if they take care of that for me. thanks!

I am a social worker here in Spokane. I am pretty sure you will have to apply for Medicaid yourself but you never know.  You may also have to be elderly or disabled with SSI to qualify for Medicaid. I work with elderly so I'm not positive. When you send the application in, if approved for Medicaid, it will take effect the day they (DSHS) received your application. My sister is scheduled for July 30th with a doc at Rockwood. She really likes them there.

I was self pay (Home equity loan) . My insurance (Uniform) had an exclusion . They didn't change their policy until 1-2007 . I found out that they were changing pre-op , but by the time I found out I had done all my prerequisite testing . I would have had to literally start over . It would have delayed me by 1 1/2 years between required diets , referrals , redoing all of the tests , surgeons wait , etc ... Frankly , I wasn't willing to wait . I was afraid I would have a heart attack , stroke  , or become disabled . My insurance paid for most of the testing , because of how it was worded on the orders . some things I did to reduce complications were : being really serious about weight loss pre-op (it shrinks the liver) , took lots of vitamins , & drank at least 2 shakes a day . The protein in the shakes boost your immunity & aids in healing . To lose weight before the pre-op liquid diet I drank at least 2 shakes a day & ate a good high protein , low carb dinner . If I really wanted a snack i'd eat a piece of fruit . I lost 20 pounds up to the liquid diet phase & an additional 10 pounds during the liquid diet phase . I didn't have any problems other than getting a little dehydrated early on , which caused my blood pressure to get a little low . It was worth every dime . I didn't go to Mexico to have surgery because if I did have a complication , I wanted to be close to home . Kathy

Thanks for your note, Kathy. I saw my MD yesterday and he told me to just let him know when I wanted to do this as all is in place. My husband and I want to go to the hospital and talk with them first because being private pay we have heard from the Dr and other patients that you can sometimes meet with them and talk about the "bill" and if you are cash or private pay they may reduce the cost. So, again thanks for all of the info, it was very helpful. I am thinking about September. Congratulations on your hard work!!!

Cheryl

My surgeon has a private pay price . Not counting any testing etc... that I paid for , my surgery was $ 24,500.00 for open RNY . That was surgeon , assistant surgeon , anesthesiologist , & hospital . It was $ 1,500.00 more for lap RNY . I had open because of my particular procedure . I'm not sure how much they charge insurance , but I know it's way more . Kathy