any luck switching insurance to gain coverage?

[litalo 2]

kind of typing through the tears here...after having one center tell me that not only was my CIGNA plan covering the VSG in full, but even at a 3 mo instead of 6 mo turnaround, the doctor who I finally chose to move ahead with discovered that my actual policy has an employer-imposed bariatric exclusion. I was supposed to meet with the surgeon on Friday. This was all supposed to be pre-screened three weeks ago when I made the appointment with him, or at least discovered a month and a half ago when the other ins. coordinator supposedly contacted CIGNA. To rub salt in the wound, when DH asked the HR rep about if it was an across the board exclusion, or if there was a better policy he could get at open enrollment (next week), she said that bariatric services aren't medical, so they don't cover it. (more tears. i'm not in this for the smaller jeans; its the very real Type 2 diabetes, the high blood pressure, and various other metabolic issues that somehow aren't 'medical problems.' And the biggest crime in this? He works for a NA Casino of a tribe who has rampant issues with diabetes and obesity. And its a casino that brings in money hand over fist, yet they can't take on the extra liability of the surgery to make their employees healthy (I don't know however if the tribal insurance covers bariatric services. that would be an even greater slap in the face)

so i'm trying to come up with plan b. Right now, I am very nervous about Mexico. Mainly due to the follow up and what would happen to us financially if I had any surgery related complications. Our policy excludes ANYTHING to do with bariatrics. So if I had a complication with my bariatrically modified stomach or health, I have a feeling that it would not be covered. (DH will ask this specific question to the CIGNA rep at open enroll next week) (I once had spasmed my jaw muscle trying to bite a small apple in half--don't ask it was to appease two fighting children in the backseat of the car who both wanted the one apple. My PCP coded the paperwork as a TMJ spasm, and the office visit was denied because even though it wasn't a TMJ issue, it said TMJ on the paperwork).

another brainstorm i had was getting my own BCBS plan and running the surgery through that. There wouldn't be any savings on the monthly premiums, so it would be a big monthly expense to add on. And that isn't even factoring in taking preexisting obesity (now that that is a medical diagnosis they recognize) or type 2 into consideration.

am i grasping at straws here? is mexico my only option?

[Takingcontrol 467]

I had the same exclusion...so I had my hubby add me to his plan & got it covered!

[litalo 2]

I had the same exclusion...so I had my hubby add me to his plan & got it covered!

super awesome for you. i don't have that option as I am self employed and am already on my husband's insurance.

[Daydra 345]

If you think that you might be able to afford the monthly payment of an additional, individual policy (I've heard rumors that individual policies rarely cover bariatrics, I have no idea if this is true), what about just financing the procedure in the US? Mexico is an option, but you have to remember that you have to add all travel expenses to your total cost, though many still find that cost effective. There are some companies that finance medical procedures. My clinic uses Bliss and Care Credit. They recommended I try Bliss because they had better rates in general. My clinic also offers, through Bliss, 90 days of insurance against complications in the cash price (I bought up to a year, it was only about $150 out of my pocket for the buy-up). I financed about $18,000, didn't get the lowest rate, and my payment is under $400/mo, which depending on your age and individual insurance plan options is pretty comparable to a premium. And I don't really have to worry about complications, because I'm backed by insurance on that.

Another note... When they do things like the upper endoscopy, they code it for GERD, so insurance often covers it. That brought my cash price down almost $3000. As the insurance billings come in, we're finding that they are paying for some of the items we didn't expect them to pay for, so I anticipate getting some money back after all is said and done.

There are definitely options. All is not lost. You just have to sit down, think really hard about the possibilities, and figure out a solution.

Best of luck to you!

[lucky8mb1 167]

My policy excluded bariatrics entirely and since my husband and I have the same employer - there was no switching onto his. For me, looking at an individual policy was too risky considering all of my other potential medical needs. I'd rather have my partially employer subsidized insurance because for things other than bariatrics - it's not too bad.

I just bit the bullet and self-paid in the US. It was about $12k for the doctor and hospital fees. I was able to get all of my pre-op testing covered by my insurance by going through my PCP. This helped cut my costs a bit. At the time, I wasn't crazy about putting out all of that money - but now I'm so so glad that I did.

Good luck to you. I hope you're able to find a solution that works for you.

[ecip78824 20]

I had the exact same issue. I even had my first doctor stop returning my calls once he found out about the insurance exclusion. It was really heartbreaking to build up the courage to talk to my PCP, attend a seminar, and make/attend an appointment with a bariatric surgeon just to have them completely drop me when they found out that my insurance wouldn't cover the surgery. The last thing that that surgeon had said to me was to look into changing insurance plans. However, I found that paying for private insurance that covered bariatric surgery would cost about $1,000 a month. I would have to enroll for a year, so it'd cost me about $12,000 plus whatever co-pays I'd have for the surgery and pre-approval process PLUS there would be the wait for the approval. I started looking for other options and found that there are parts of the country that are more competitive and thus less expensive than others. I'm having my surgery in Plano, Texas, with a Dr. Nicholson. He is a very highly experienced doctor who charges $12,200 for the surgery, which includes all pre-surgery screening and two nights in a hotel. They work with a lot of out-of-state patients and although I have the same worries as you do about complications and their cost, I find a lot of solace in knowing that Dr. Nick has had only a handful of leaks among his patients. I know it's still not an ideal option since $12,200 plus travel expenses is no small expense, but it is so convenient to be able to just call them up and schedule an appointment within a few months and not have to deal with a huge pre-approval process and fight with an insurance company about co-morbidities. They also accept Care Credit and I've heard that they allow you to split payment between credit cards and cashier checks. However you do it, I hope that you find a way. Good luck!

[litalo 2]

thank you all for the encouragement and helping me see outside the box here. This news hit me like a load of bricks and it's been a pretty horrible day. I didn't realize about the medical financing and the alternative coding, and shopping in different markets. I'm in Southern AZ, and while my surgeon of choice is very good (and is a leader in VSG from what his resume says), i can probably look into Phoenix, So. Cal or Texas. All of which would be very reasonable for travel.

really. thank you so much for the other things to consider. i appreciate a little glimmer of hope and some commiseration.

[jensjoy28 351]

I was a cash pay and was able to get a personal, unsecured loan through my credit union for less then the interest rates offered through the medical financing options.