Dont Understand

[papike 3]

I just dont understand why the insurance companies make us jump through so many hoops for this wls surgery. We dont jump for the other surgeries like gallbladder etc,, and they are almost the same,or am I wrong to feel this way?

[mcdoja 33]

I think they want to make sure it's a sound investment from their standpoint, it costs like $40,000. They want to make sure you have a good chance at success. When successful? They are saving $100,000's down the road from quadruple bypass, diabetic amputation, and stroke treatments, not to mention the cost of medications, etc. yep, they're for-profit, not kindness.

[papike 3]

so i guess they dont care if the other surgeries work or not?.....lol

[mcdoja 33]

You have to get most other surgeries. But yes, when they remove your gall bladder it always works. Lol

[Sparklette 381]

Weight loss surgery isn't considered "necessary", at least not yet. It is considered a voluntary surgery.

But yes, like Mcdoja had said, the surgery is an investment for them. My mother has type 2 diabetes, on average, we spend somewhere around 300-500 dollars a month on her medication/tests/doctor etc. Our insurance pays 85% of the cost. So if we're spending around 400 dollars, the insurance is spending a little over 2,200 dollars. That's one month. For a year, that comes out to 26,000 dollars. My mother has been diabetic for 8 years, and let's say she lives to be 65. That's 23 years of spending 26,000 dollars. That's 600,000 dollars, OVER HALF A MILLION.

And that's not including complications that can arise, Heart issues, Blood pressure issues, sleep apnea, Amputation, hospital visits, all of which could easily arise to a million dollars, for one person.

That being said, they want to make sure that we will be successful with this surgery, which is why they send us through the hoops, because they want us to succeed, and they want their 64,000 dollar investment to be worth their while. Trying to save a million dollars.

[Jeepchick42 193]

Most insurance companies realize that 99.9% of their subscribers will not be on their insurance plans for the rest of their lives. Most people don't stay at one job for the rest of their lives and if they do, companies change insurances all the time. I've been working since I've been 18, I'm 31 now and have had 5 different insurance companies in that amount of time. One insurance company will not be responsible for for my medical bills for the rest of my life. This is the way the insurance companies look at they're subscribers. Yea they may have to pay your bills for a period of time but then you'll be on to the next one. Also they realize that 65% of medical expenses are going to be in the last 20 years of your life, where as when you are young, you tend not to use their services. This is the way they can justify not spending 20-60,000 dollars on an elective procedure. I'm 31 years old and besides this procedure I haven't had any other health issues. Besides my yearly check up I can't even remember the last time I was even at the dr. I have health insurance because it is mandatory in my state and just in case something major happens. And it costs me about $400 a month for just myself. And I work for my insurance company. They are making a HUGE profit off of me. Health insurance is big business and they all make a tidy sum.

[Jeepchick42 193]

Oh and it totally sucks!!!

[deaddemmama 474]

Don't even get me started on insurance!

[ElleG 394]

I think insurance companies want to make sure u have really tried to loose weight, you will stick to the new lifestyle and u are mentally ready for what's in store.

It saves the insurance co's money if they can get us healthy so it's worth the money. I know mine pays a lot for me to see numerous doctors/ specialists. We all want me healthy. My heart doctor is special to me and I discuss things with him before I do it. If he supports me and he says my heart is strong enough for it. I do it plus he wanted me to loose weight too. I have a great team, they all supported the RNY so it made getting approved easy, they all wrote letters or addressed it in their notes.

It's best to have everyone on the same page because we all want the same thing in the end!!

Best Wishes 2 U All!

[ElleG 394]

I should add I have been with blue care network / blue cross blue shield 20+ years. They know my history, that also helps!