What Insurance Can I Take Out To Cover Sleeve?

[Candace Dillard Stewart 1]

I want to have to sleeve done...but as of right now I do not have any insurance...is there anyone who has taken insurance out and gotten the sleeve done??If so what kind should i take out?

[Wheetsin 714]

Do you mean a personal policy, where you pay out of pocket, or do you mean selecting an insurance plan offered through your/spouse's employer?

Some companies completely exclude certain bariatrics. The sleeve is becoming more allowed, but is not yet as widely allowed as the RNY or AGB. If you're talking about joining a group plan (through your employer, or a spouse's), you would need to see what the available coverage options were and contact the insurance companies to see if they had plan enforced exclusions for the sleeve. You would then need to contact your HR and see if there were any employer enforced exclusions for the specific procedure. Just because an insurance company considers the sleeve a covered procedure does not mean it's one of the options your employer has paid to have included in their coverage.

Coveragte under a private/personal plan would have similar caveats. You'd have to qualify for the plan, for one - depending on your past medical record and current health this may be hard to do, and will almost guaranteeably be more expensive (e.g. b/c I've had bariatric surgery, I would be considered uninsurable by a lot of private plans, and a self-employed friend of mine who is in the super morbid obese category is uninsurable because of his weight.) You would still have to meet all the requirements. And you're looking at a very hefty premium, and probably a good chunk of coinsurance to boot. It's also fairly common to have waiting periods (that's my own term, not the technical term) -- periods of time, generally 3 - 6 months, that you have to wait while actively paying premiums before you're eligible to receive certain benefits. I'm going to bet that bariatrics are included in the procedures that require the waiting periods.

IfPrince out a private plan, and find out if they require the waiting period. Then find out the cost for all the preliminary stuff you will need to do such as (most likely) supervised diet, nutrition classes, consultation, pre-op labs, etc. You might find that all those costs are more than the self-pay price of a sleeve (my US surgeon charges about $11k). This isn't a conversation about whether or not you should have health insurance, so I'm not factoring in things like coverage for complications. I'm just looking at the "for procedure" costs.

[Candace Dillard Stewart 1]

Yes I was talking about Private Insurance because as far as I know my insurance at work and insurance at my husbands job neither cover any bariactric surgery...so I'm not really sure what I should do because I dont have any credit so I'm sure I woudn't be able to get financed...

[Wheetsin 714]

I don't think a private plan is going to be economically your best bet. Private pay plan premiums are really expensive. They get more expensive depending on your age, health, where you live, your salary, etc.

It's hard to ballpark this, but I'll try. These are just really, really loose figures. A healthy "preferred" person on private insurance might pay $600 - $700 a month just for the premium. That does not include coinsurance. As soon as an underwriter sees something they don't like on your application or in your medical history (obesity, diabetes, high blood pressure... basically comorbidities) your rates are going to go up and that's if you're even considered insurable - they can easily say "we won't cover you." I would suspect rates in these instances (obese with comorbidities) could be around $850 - $1000 per month for premium only.

If bariatrics aren't excluded on your policy, you're going to most likely have a 6 month supervised diet, possibly 12 month. That's $5700 - $11,400 just in premiums while you wait. That's a part of why the medically supervised diets are required. Popular notion is that it's to prove you can follow a diet, but don't be surprised if I say it's (at least partially) because the insurance company is a business and businesses need to make a profit, and they want some sort of "investment" from your end to ensure they aren't just going to lose money on you. There may also be an additional waiting period before your eligible for benefits like this, that would not usually count toward the time period of your medically supervised diet.

Then your coinsurance, which is probably going to be at least 20% but should not exceed 50%. And your deductible (which could be per condition or per year - you'd probably be per year).

When you see self-pay options ranging from about $4k to about $15k, it's easier to understand why most people pay it rather than pursuing insurance options such as the one you're considering.

Now for greener pastures...

Are you sure you don't have credit? Lots of things establish credit, which you might not be aware of. Car loans, student loans, mortgages, credit cards, etc. You can always check your credit for free, but you'll probably have to pay a small fee (I think about $5) to get your FICO or "credit score" - the number you hear talked about in all the commercials.

If you have a surgeon/hospital in mind, call them and ask if they offer payment plans. There are also companies whose sole business is offering medical loans, and I've seen a lot of people in financially bad situations get approval. Interest rates are out the wazoo, and you really really won't want to miss a payment, but all things considered it really could be cheaper than the private insurance option.

As for what companies - UHC and BCBS are the most "bariatric friendly" companies IME and in my research.

HTH. Let me know if you have any questions.

[Wheetsin 714]

Sorry for the typos above, but I'm too lazy to go back and edit.

[Bedhead 158]

What about instead of paying hundreds every month for a 3rd ins which may or may not cover bariatrics, or taking out a line of credit- you just put that money into a bank account and go self pay without getting yourself into a financial situation?

[Candace Dillard Stewart 1]

I would love too but it would probably take me a couple years to save it all!!! I guess that will end up being my only option and if I haven't had the weight loss by the time I get the money saved then at least I'll have the money!!

[kczar 166]

I want to have to sleeve done...but as of right now I do not have any insurance...is there anyone who has taken insurance out and gotten the sleeve done??If so what kind should i take out?

I've been reading this forum the past week and decided to register to give you some information.

I've been without insurance for years and needed to to get my gallbladder removed. After doing some research, I found the pre-existing insurance plan. It's a government program available in certain states. Go to www.pcipplan.com and check it out. The only requirements are that you have been without insurance for at least six months and either have a pre-existing health condition or a letter showing you have been turned down for insurance (not hard to get - I got turned down strictly because of my BMI.) It's a PPO plan and I pay about $300 a month. They require a six month diet and exercise plan but otherwise it looks like they cover it.

Good luck!

[mrsnate 55]

I agree about PCIP. I live in Arizona and pay $188/month (based on age) and YES! They do cover the VSG. I am just waiting on my surgeon's office to submit the paperwork, but I have the printout the insurance company sent over with the requirements and coverage information and I've done them all. Good luck to you!

[Wheetsin 714]

Here are the actual requirements:

To be eligible for the Pre-Existing Condition Insurance Plan:

For children under age 19 or persons who live in Massachusetts or Vermont: You must have been quoted a premium of 200% or more of the Pre-Existing Condition Insurance Plan premium for the Standard Option in your state.

• You must be a citizen or national of the United States or lawfully present in the United States.
  
• You must have been uninsured for at least the last six months.
  
• You must have a pre-existing condition. To prove this, you will be asked as part of the application process to submit one of the following documents dated within the past 12 months:
  
  • A letter from a doctor, physician assistant or nurse practitioner stating that you have or had a medical condition, disability or illness. This letter must include your name and medical condition, disability or illness, and the name, license number, state of licensure and signature of the doctor, physician assistant or nurse practitioner.
    
  • A denial letter from an insurance company licensed in your state for individual insurance coverage. Or you may provide a letter from an insurance agent or broker licensed in your state that shows you aren’t eligible for individual insurance coverage from one or more insurance companies because of your medical condition.
    
  • An offer of individual insurance coverage that you did not accept from an insurance company licensed in your state for individual insurance coverage. This offer of coverage has a rider that says your medical condition won’t be covered if you accept the offer.
    

My understanding of PCIP was that it is intended to provide insurance for people denied group or personal insurance because of a pre-existing condition. i don't think it functions as "insurance on an as-needed basis," where you can opt not to have insurance until something is wrong, then pick up the coverage just to get the treatment you're after. If that were the case, everyone could just wait until they needed something, then pay a few months' worth of premium and get extraordinarily reduced healthcare coverage, regardless of physical condition. But I'm not a PCIP administrator, so this is just IMU/IMO.

The Pre-Existing Condition Insurance Plan (PCIP) was created as part of the nation's new health insurance law, the Affordable Care Act. The PCIP program was designed to make health insurance available to you if you have been denied coverage by private insurance companies because of a pre-existing condition.

Sorry for the weirdness above, quote tags aren't working and I get "error on page" when I try to quote through the GUI controls.

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[Candace Dillard Stewart 1]

I have been denied by BCBS because I am overweight, and I do need insurance not just for the sleeve surgery but for many other health reasons as well..so I will have to look into this

[mrsnate 55]

I was without insurance coverage for more than 9 months because I was denied coverage from BCBS as well, in my case for PCOS and weight. I will be keeping the PCIP insurance as long as it's available to me because right now it's my only option.

[Candace Dillard Stewart 1]

I am applying for it now, I wonder what is the best option, the lower deductible and higher premium or lower premium with higher deductible? Which one do you have?

[kczar 166]

I am applying for it now, I wonder what is the best option, the lower deductible and higher premium or lower premium with higher deductible? Which one do you have?

The coverage varies from state to state (and not all states are included), but I went with the standard option. At the time, I wasn't really thinking about wsl. I needed it primarily because I hadn't had insurance in 10 years(!) and needed gallbladder surgery. I took the difference between the two premiums, multiplied it by 12 and then compared that amount to the maximum out of pocket. In my case, it made sense to go with the higher deductible. I just had my gallbladder removed and that should cover my out of pocket maximum for the year. If that's correct, the vsg surgery should be covered 100%. They do require six month's medically supervised diet and exercise program, but I think that's a good thing. It gives you time to mentally prepare yourself for this change in lifestyle.

Anyway, good luck to all those that apply. It was an extremely easy process and I was covered within 45 days of sending off the paperwork. I don't regret it a bit! Just keep in mind that this plan is supposed to go away in 2014 when major health insurance laws go into effect. But we all know a lot can change in that time.

[mrsnate 55]

I also took out the standard option. The maximum out of pocket for both the standard and the extended option was the same and I figured my surgery will max out my out of pocket anyway. Keep in mind, I didn't get the insurance specifically for wls, but it has been on my agenda for about 5 years! Like kczar said, it is supposed to end in 2014 when "better conditions for insurance companies will be in place" but all that can change. For now I'm grateful to have it.