Aetna says NO coverage

[Tanyac 31]

I'm with Aetna signature administrators and they said that there is no coverage for weight loss surgery even with letter of medical necessity. My bmi is 52 and I'm suffering at this point. I don't have the money to pay out for the surgery. I'm going to the seminar at the hospital anyways because they said that they may help get me financial assistance from the hospital but I think my hubby may make too much money. Anyone have this experience?

[AmandaRaeLeo 2,146]

WLS is excluded from my insurance policy. I withdrew $$ from my 401K and went to Mexico on 3/18/13.

So far, so good.

[Tanyac 31]

So you can take out from 401k for surgery?

[Ms.AntiBand 2,984]

WLS is excluded from many peoples policies... It's sad, but it's final in regards of insurance coverage. There are a few very doable and positive options out there. If you want the surgery bad enough you can find the way.

Some people feel they won't be around long enough to see their retirement/investment monies due to their health .. so why not spend it on your life now?

It's doable.. Good luck

[BKLYNgal87 503]

It's not Aetna, it's your (or your husband's) employer. They dictate the plan Aetna offers. My Aetna plan covered WLS for a BMI above 35 with comorbidities and above 40 with or without comorbidities.

I agree with the others - borrowing the money out of your retirement savings is a worthwhile investment.

[Tanyac 31]

I didn't know the money could be taken from 401k! I have money invested.. is there a big penalty to withdraw from that for surgery or do you just suck it up and pay the tax hit? My hubby will gladly take the money out without question, he wants this for me too. Do you have to get the surgery done in the u.s. if you take it out of 401k?

[Will 61]

Tanyac, I have no idea how it works with taxes, but I know that if the surgery is more than 9.5% (I think) of your annual income, you can write it off in taxes.

[Tanyac 31]

This is amazing information thank y'all so much this is actually giving me some hope.

[angied 39]

You can also apply for Care Credit and/or refinance your home mortgage with a cash out option. There really are a lot of options - where there's a will, there is a way. My insurance doesn't cover it either, but I have some money saved up that I'll be using. The hospital also gives a discount if I pay in full within 30 days of the surgery. Some hospitals even offer a package rate - you might have to make a few calls. Its totally worth it. My surgery is in October, and it can't come soon enough

Good luck!

[Jason_in_Texas 9]

I have Aetna PPO and they approved me - it just depends on what your plan terms are.

Borrowing from your 401K may be a cheap way to get money IF your employer's 401K plan allows you to take loans (not all of them do.) If it's a distribution (not a formal loan) then you will have to pay a 10% penalty fee plus full income tax on any amount that is distributed (which really hurts - you will likely be giving 50% + of the money you take out to the IRS.)

Does your company offer more than one insurance option? My company lets you pick which plan you want every year and there may be a PPO plan option that covers your surgery. Also, there may be a plan with a Health Savings Account, and those are good as well. You deduct money straight from your pay check and it goes into the HSA un-taxed. You can then use that money on medical expenses (includig bariatric of course.)

You can of course write off medical expenses that exceed 9.5% of your gross income (changed from 7.5% with AHCA), but that may not be a great deal either. For example, if you and your husband make $80K a year then you could deduct health care expenses in excess of $7600.

Another option would be looking for a job with an employer that has better insurance. It may not be easy but it could be worth a lot of money to make a job change even if the salary is a bit less.

[Tanyac 31]

we have an old 401k that is sitting there collecting dust. I'm not working so he is head of household we live in Chicago and i think the surgery is a lot more than 7k and for right now it's an option i will explore further but i'm looking at everything right now. unfortunately there is no other insurance at his job. thank you all again i'm taking all this into consideration. like she said if there is a will there is a way

[AmandaRaeLeo 2,146]

we have an old 401k that is sitting there collecting dust. I'm not working so he is head of household we live in Chicago and i think the surgery is a lot more than 7k and for right now it's an option i will explore further but i'm looking at everything right now. unfortunately there is no other insurance at his job. thank you all again i'm taking all this into consideration. like she said if there is a will there is a way <img src='http://www.bariatricpal.com/public/style_emoticons/<#EMO_DIR#>/smile.png' class='bbc_emoticon' alt='' />

I don't know if you are open to Mexico but surgeon costs range from 4k - 10k. All inclusive except airfare.

[Tanyac 31]

Mexico seems risky anyone have it done there?

[AmandaRaeLeo 2,146]

Mexico seems risky anyone have it done there?

I did, this past March.

I researched Mexico for months, flipping and flopping between surgeons until I found Dr. Aceves in Mexicali.

They took excellent care of me. Truly. He is one of the more expensive Mx surgeons. 8750, but your recovery is inpatient for 3-4 days in a full service hospital.

Many surgeons in Mx have you recover in a swanky hotel near the hospital and do the follow up care at the hotel. I wanted, and needed, to be a hospital for my recovery.

[TARPHR 29]

My hubby and I were sleeved last Wednesday in Tijuana Mexico by Dr Corvala. I would highly recommend it! 6700.00 plus airfare!!

No complications!