BCBS will not pay for sister who works for City

[JazzyJan 1]

Hello everyone, I have a sister who is needs this surgery so bad due to health issues, problem is she works for the City of Tomball and will not cover her surgery and she cannot afford to pay for it out right. She has BCBS just as I do, but I work for a University and they covered most of mine and I was able to have it done. I just wanted to see if anyone had come across this problem, and if you know how to get around it. She has all the health issues needed and more and her BMI is well above the 40%. Thank you for any suggestions.

[lessofmeismore 1,405]

I have BCBS and they would not cover my surgery. There was no way around it because my plan with BCBS had an exclusion for WLS.

A lot of companies unfortunately have these exclusions.

I went with self pay. I was very sick and the surgery saved my life.

Has your sister looked into surgery in Mexico?

[Ms.AntiBand 2,984]

Each work place policy covers different things and it sounds like your sister's work place policy excludes wls? Or does her policy include wls, but she is being specifically denied?

[JazzyJan 1]

I am afraid the City she works just doesn't cover the Gastric Sleeve surgery, someone told her she could appeal the decision but I know she wouldn't do that. No she hasn't looked into doing it in Mexico, but knowing her I doubt she would go to Mexico, but certainly something to think about. I am thinking my family members should go in together and help her pay for the surgery, I am afraid if she doesn't have the surgery and lose the weight it will kill her. I apprecaite everyones comments and suggestions.

[VSGJean 68]

My husband's city insurance (UHC) wouldn't cover WLS and neither does his new Parish insurance (BCBS of LA). I went to Mexico and it was the BEST decision I've ever made. If she has any questions about Mexico, have her get in touch with me!!

[JazzyJan 1]

Can you tell me more about going to Mexico? Where do you go and approximately what is the costs?

[VSGJean 68]

Can you tell me more about going to Mexico? Where do you go and approximately what is the costs?

I went to Puerto Vallarta, My surgery was $4500 plus an extra $500 to go to PV (It's an upgrade) I would've gone to Tijuana but I had a friend that went with me. I flew with United and YES you have to have a passport.

Go check out my Youtube page. I've been documenting my journey. I also have a 14 minute video of my trip to Mexico posted there too. VSGJean!! If y'all have anymore question, private message me on here or Youtube and I will give you my contact info.

[Aquila Zion 2]

I went to mexico $4500. for the surgery, I called the weight loss agents and it went well for me, you might want to check out others but this one was true to the details for me. They answered all the questions you need to know .

[JazzyJan 1]

I can't tell you how helpful this information is for us on Mexico, I had no idea....I can't wait to tell my sister, thank you so much

[zoekids 120]

Hi, I am another person who went to Mexico .. OCC. It was slight more expensive than quoted above.

Mary

[sarahzamudio1091 185]

I can't tell you how helpful this information is for us on Mexico' date=' I had no idea....I can't wait to tell my sister, thank you so much[/quote']

There are also a forum strictly for the Mexico patients on VST

[Nesa 51]

I'm being told my hospital stay is approved but I have to wait for my sleeve to approved. I'm so nervous now that I'm going to be denied. I work for a bank. I have completed everything that I was asked for in 6months

[Mel1071 149]

The only chance you stand of getting around the insurance company excluding coverage for WLS is to find out if your insurance is "self-funded." This is what my center told me - unfortunately mine was not. Apparently they have had some limited success getting self- funded policies to provide coverage.

And if you're like me and wondering what the heck self-funded means, check this out: http://en.wikipedia.org/wiki/Self-funded_health_care

[Nesa 51]

The only chance you stand of getting around the insurance company excluding coverage for WLS is to find out if your insurance is "self-funded." This is what my center told me - unfortunately mine was not. Apparently they have had some limited success getting self- funded policies to provide coverage.

And if you're like me and wondering what the heck self-funded means' date=' check this out: http://en.wikipedia.org/wiki/Self-funded_health_care

Thank you very much I will look into it. I hope I get approved specially everything I've already done.

[Nesa 51]

So my insurance now will only cover it if I have sleep apnea type two diabetes or some heart disease either one thank god I don't but I think I have sleep apnea lol so there gonna send me to test for that. I am borderline line diabetic but that's not enough unless my doctor prescribes me meds =(