For all of you self-pay VSG'ers.. Why did insurance deny you?

[Pinkbetty25 1]

Hi!

I am thinking I am most likely a self-pay. Most of this is baby weight, and I am leaning towards Dr. Pompa in Mexico.

So, for all of you out there going to Dr. Aceves, Almanza, etc. who are self-payers... Why did insurance deny you?

Thank you! And Happy Friday!

[MlkPas 5]

My insurance only covers WLS for "morbid obesity," and since my BMI was only 32 there was no way I was going to be covered. Simple as that -- I didn't even both applying. We were fortunate to have an income tax refund this year that was large enough to pay for my surgery, and I was very happy to be able to make it happen on my timetable, without jumping through the insuance company's hoops!

[Ihave6kids 29]

My insurance would cover but only with medical issues. Then if I could get past that hurdle it would still cost 15,000.00 Ugh. I went to Mexico for 7,000.00

[lunarose 97]

I have Kaiser and you have to have a BMI>40 if you do not have diabetes. My BMI is 36 not diabetes and my HTN , high cholesterol, carpal tunnel, and joint issues are considered below 40. I really did not want to have to gain more in order to get them to qualify me especially since their wait time is close to a year.

Nancy

[pnw218 14]

Mostly the same here as well. Never applied to the insurance. Requirements for our plan was a BMI of 35 or more with other medical issues (which I had) or 40 without. My BMI was only 33. They also tho required a one year doctor supervised diet and exercise program prior to even approving surgery. My out of pocket would have equaled or exceeded the $6k I spent going to Mexico - and I had the surgery in three weeks. Have never been known for my patience anyways : )

[Stacy160 201]

My insurance didn't deny me, I just never bothered with it since ANYTHING weight-loss related, including surgery, is a specific exclusion on our policy. That's the the insurance's fault, it's my cheap-ass greedy s.o.b. employer (who really is a horrible person in many ways, I'm not just an angry employee LOL) who chose to go as cheap as he could get with our policy.

[Krista2653 5]

Weight loss anything was also excluded by my employer....

But! After I look at what other people have been through with insurance, I'm glad it was! The hoops that some jump through only to be denied and the waiting....ugh. I figured that after paying co-pays, deductibles, co-insurance, etc etc etc (especially when it would have been $50 for each visit with a surgeon, psych, nut, etc)....I'm not paying much more then I would have anyway....and it is on MY terms and on MY time. Wouldn't have it any other way!

[nurse_ally's mom 0]

Posted something similar to this on another thread just a few minutes ago.

I don't want to hassle with the insurance. I deal with insurance idiocy in my job every day, and I want to be in the driver's seat with my health issues. I had surgery scheduled with Dr. Aceves, but had to cancel due to knee injury/surgery problems. I will be rescheduling when these problems are resolved...not when someone else tells me I can. Do I have control issues??? Surely not:)

[shrinkinggrl 0]

after being cancelled 2 x for the lap band, I started feeling that maybe it was a sign I shouldn't have that surgery...and in the middle of the 2 cancellations I started reading about VSG. And then I found out my ins. co considers it experimental. I knew I could apply, get denied, and appeal, but I was just so fed up w/ all the waiting, the hassle, the red tape, the "just days before surgery cancellations" that I said screw it and found a way to pay in Mexico. LOL

[KathyM 14]

My BC/BS says it will "not pay for any services related to the treatment of obesity." It did however pay $27,000 for my knee replacement, it will pay for my arthritis medication, it also pays for my blood pressure medication. When I was researching my policy limits before my surgery I noticed that it will even pay for treatment of erectile dysfunction lol. It will pay for all of the effects of long term obesity - stroke, heart attack, nursing home care, etc. But nothing preventive so you don't get to that point. :thumbup1:

[6kiddos 18]

I am hoping to not self pay...

I am currently going through all the hoops...but I am lucky (IF I get approved). My ins pays 100% of the surgery (after I hit my $5k deductible...which I hit with treating my TMJ and having an uterine ablation done this year..moles removed, etc). I have decided that this is the year for medical things for our family since we hit our family deductible of $10k in June. (dd needed sinues surgery, allergy testing, etc). So....we are slammed with dr. appts right now trying to get everything taken care of. =) I am HOPING they approve the sleeve for me. My BMI is 50. (I hit that requirement but I don't have any comorbities...yet.)

If I am denied we will probably look into Mexico and pay out of pocket.

[Lina P 0]

I'm in Canada so insurance doesn't pay here unless you have a BMI of >40 and comorbities. My BMI was only 37 so I didn't bother applying.

Takes too long to get approved here anyway. I hear the wait in Canada is over a year and you have to go through testing after testing.

My GP wasn't comfortable with me going to Mexico so she gave me a number in Michigan. Self pay they wanted $25,500 for either sleeve or GBP.

[jamey 1]

According to Kaiser, I could either gain more weight or just sit around and wait until more comorbidities developed. I didn't like either option so I self paid at UCSD in San Diego. I am so happy and feel amazing. I looked at the loan as a new car, only this vehicle is going to last me for the rest of my life!

[a.walker 2]

My insurance had a lot of hoops to jump through before surgery. I would have to be on a 6 month physician-supervised diet. So, going to the doctor 6 months x $35 co-pay. Then they want you to have a sleep study done (on your own dime, because I really have no reason other than my fatness for them to think I need one). Then there's the psych eval, EKG, etc. The costs piled up before my very eyes. Add to that, I only have the plan that costs me $200 every 2 weeks, instead of the one for $325 every 2 weeks, and my deductible is (I think) $2000 per person, or $5000 for a family. Then they pay 80%. My co-worker went through all these hoops and got RNY a year ago. What she ended up having to pay was over $8500 and she has the better insurance.

I decided I would take out a loan instead. I went to Mexico and had it done for $6700 without the 6 months and possible denial drama. I am happy with that decision!

[pumpkin07 32]

My insurance, United Healthcare, excludes weight loss surgery and complications with my husband's employer in Houston, Texas. But I stuck with an American doctor in my hometown for reasons that made sense to me - like in case of complications I wanted to be under the care of a local, respectable, bariatric surgeon specialist. Paid almost 15k and it was worth the peace of mind. I see some are 12k now.