Discouraged

[thesleevitegroupie 0]

So I found out that my husband's Anthem BCBS PPO Blue Access excludes bariatric surgery. I'm so broke hearted! I know we cannot afford to do this on our own. The office director at my Bariatric surgeon said that there was no way around it. Anyone have any suggestions? I live in Indiana...

[Mel1071 149]

My surgeon's office said the Only possible way I had a chance of getting around the exclusion clause is if my insurance is self funded - then I might be able to fight it. We,, it wasn't . Our insurance had an exclusion and it was not self-funded so I went the self-pay route. Self pay can run from 4-5K (Mexico) to 20K+ (in the states).

[thesleevitegroupie 0]

Thanks for sharing. I'm really praying to find another way.

[McButterpants 2,846]

Yeah, my policy had the exclusion as well.

My surgeon suggested talking to the Human Resources Department to see if there was anyway they would pay for the Weight Loss Rider - I have no idea how much that costs, but my company wasn't willing (they are actually increasing our rates by 13% next year for the same coverage). If your husband is willing to talk to them about it, it may be worth a shot. They worst thing they can do is say "no".

Good luck, sweetie!

[Ms.AntiBand 2,984]

Don't give up. Our insurance also exculdes WLS, but even if they didn't I would have gone to my surgeon in MX. Their experience and care have won my trust 100 times over.. Enough to where my girls are going soon and one daughter has insurance coverage here. It's a choice of what you want and are confidant with.

Again.. Don't give up and you'll get your sleeve. If you want it badly enough it's yours

[thesleevitegroupie 0]

Thanks! You all have been very encouraging. Question: when you went to Mexico for your surgeries, did the $4-5K cover airfare and hotel or just the procedure?

[Kindle 8,667]

My insurance completely excludes any type of WLS, too. I'm going to Mexico for my sleeve surgery on 12/20. I will end up paying about $7500 for surgery, extra hotel nights for my myself and a companion (we are coming in a day early and staying an extra day), airfare, and 2 months pre and post op Meds, Vitamins and Protein supplements. I'm going with Dr. Ortiz at Obesity Control Center. His surgery cost is a little more expensive than some other Mexico options, but my 6 months of research left me feeling like he was the best and safest choice. PM me if you have any questions about my research and decision.

Good luck!

[Abigal 13]

Shocking that these insurance companies would rather pay for diabetes and all the complications that go with it.

[lia2013 9]

I am the benefits manager at my company, I tried to get us a wls rider for our insurance and we couldn't even find a company that would offer us one. Seems like a lot of insurance companies are only offering wls coverage for really large groups ( my company is only about 250).

I too will be going to mexico in January.

[thesleevitegroupie 0]

This is a tough situation for me. I'm having fertility issues due to PCOS and my weight. I'm by no means looking for a quick fix. My husband and I have thought and prayed over this for a while. I just turned 39 a few days ago, and our chances for a healthy pregnancy are getting more slim by the day. I'm going to my doctor on Monday and just starting a 6 month supervised diet so I will have it out of the way if/when I'm able to have the surgery. Thanks everyone for your comments.

[tiredmama 138]

I am sorry you are going through all of this- I also have PCOS and struggled with infertility. This may be a wacky idea but have you considered looking for a clinical trial? When my insurance wouldn't pay for any further fertility treatments, I considered participating in a clinical trial. I didn't ultimately find one that worked for me but I imagine there must be some that cover wls. Good luck!

[thesleevitegroupie 0]

I've never considered that. I'm not sure where to start. I'll check out google to see what is available.

[cindymg 629]

According to this recent article the ACA will cover weight loss surgery: http://www.usatoday.com/story/news/nation/2013/07/04/obesity-disease-insurance-coverage/2447217/

You will be able to get ACA coverage but you will need to compare the cost of the ACA compared to the employer-subsidized plan your husband has. Here's a link to the article: https://www.healthcare.gov/what-if-i-have-job-based-health-insurance/

Good luck on your journey!

[Mel1071 149]

Not all state under Obamacare will cover it. Somewhere someone here had everything broken down by state. Kind of sad that not every state is treated equally. Most of the top ten obese states in the country won't have coverage

[Branmuffin 190]

You know during my sleeve venture I found out that many who work at our local hospital are/have had the surgery because after they've worked there for 90 days they have a 250$ deductible for the sleeve surgery. Maybe you should check into getting a job at a local hospital long enough to have the procedure? Just a thought.