Insurance Opted Out of Bariatric Surgery Coverage - is there a chance of still being covered?

[KB2222 2]

I have seen my family doctor who has encouraged me to have the sleeve done, however our insurance does not include Bariatric coverage.

I feel it is important enough for my health that I will self pay and have a surgery date of August 4.

Today we got word from his work stating we can appeal this and ask for coverage. Has anyone had success with this? Seems a little to good to be possible. Any information or experience you can share would be greatly appreciated.

Thank you!

[Jersrose43 837]

If it's a straight exclusion than you won't win. However who will it hurt to appeal?!?!? Go for it!

Also you should try to purchase private insurance through an exchange that gives you this coverage it would be cheaper than self pay. You can always drop it afterwards.

You will have to meet their precertofication guidelines obviously may delay you a bit. But something to seriously consider.

[KB2222 2]

If it's a straight exclusion than you won't win. However who will it hurt to appeal?!?!? Go for it!<br><br> Also you should try to purchase private insurance through an exchange that gives you this coverage it would be cheaper than self pay. You can always drop it afterwards. <br><br> You will have to meet their precertofication guidelines obviously may delay you a bit. But something to seriously consider.

Thanks for the info! We checked into the exchange but none available for coverage in WA! I am assuming we will be paying, but give it a shot anyways.

[newat52 1,613]

My insurance excluded it as well. I look back now and don't care. I paid out of pocket and would do it again in a New York minute. Lucky, I live the the Dallas area where we have an abundance of top notch bariatric surgeons. (I paid $12,200 all inclusive) Don't get me wrong, that is a huge chuck of change but SO worth it. It was the best health decision I could have made for myself. My husband agrees!

It would be great if insurance paid but if it doesn't, go for it! You will not regret it!

Best of luck to you!

[Natasha Estrada 36]

I switched to an individual plan when I become eligible in March so I could get the surgery covered. Will probably switch back to my husbands plan at the start of the new year.

[sunnkistme 76]

I am going to go through insurance, but it seems that by the time I get through co pays and deductible I will have spent almost as much as Mexico would cost. I will be out of pocket 8500.00 before insurance payss 100% f your insurance is marginal, not being covered might not be a huge financial difference.