Insurance doesn't cover surgery.

[effinmetal 9]

Hey everyone!

I've been lurking for a little while, and I need to vent. I had come to the conclusion that I was going to pursue VSG surgery about a month ago, and I was under the impression that because I have Cigna, and Cigna is accepted at Vanderbilt Surgical Weight Loss Center, I would be a shoe in.

I called Vanderbilt's Surgical Weight Loss Center to get the process going...and as soon as I told the woman on the phone my group policy #, she put me on hold, and came back to tell me that my insurance wouldn't cover the surgery.

Needless to say, I was destroyed. I had put too much hope into the potential, and didn't live in reality.

How many of you have had this happen? How did you combat it? Is there self-pay payment plans? Is this the end of the road for me?

[Inner Surfer Girl 12,015]

If your policy doesn't cover WLS, there are other options. Don't give up until you explore all options.

If you go the self-pay route you can use: savings, borrow from a bank, borrow from family, borrow from a 401k, etc .

You may be able to find an insurance policy that does cover WLS.

I found that my state covers WLS through vocational rehab.

Some self-pay people go out of state or out of the country.

If this is something you want to do start exploring and do your research.

Best of luck.

[Sleeve_Sistah85 193]

Sorry for your struggles. A lot of folks have had success with the physicians in Mexico and costs about $5000...look into it. Theres even a support group on this site for people sleeved in Mexico.

Also, check your job and see when they'll have open enrollment. You may be able to switch to a carrier that does cover your insurance.

Edited October 25, 2014 by Sleeve_Sistah85

[ProudGrammy 8,322]

my insurance wouldn't cover the surgery.

@@effinmetal

sorry this happened to you

please don't throw the towel in yet

you can appeal their decision once, then i think twice

don't give up

thats what "they" are hoping you will do

that way ins doesn't have to pay

there are special forms you can get for a denial

start at your bariatric office/or doc/surgeon

"suzy orman " says borrowing from your 401K is a big no no

i don't think a bank would give you a loan for surgery (could be wrong)

there are other borrowing situations like said

I don't know if there is a plan for paying surgery in Mexico (i kindof doubt it)

don't give up the ship yet - you hopefully won't drown

hope things work out

good luck

kathy

Edited October 25, 2014 by proudgrammy

[belovedwar 5]

My insurance didn't cover it. I bit the bullet and paid for it on CareCredit. My surgery was $14,500 + labs. I want to say it was approximately a total of $20k. My surgery was in San Antonio, Tx. I'm 6 months out and happy I did it. I'm down 91#s and have a long way to go, but it is well worth it. In January I could barely walk and now I'm enjoying my stroll through the park. This is about you and if you can afford it, do it! You are worth every penny!

[Jersrose43 837]

Did you call Cigna ?

Cigna sells many differing type of policies. However weight loss is covered is covered by Cigna.

What could be happening is the following

1- your employer specifically excludes it. Cigna can tell you

2- Vanderbilt could be mistaken. Cigna can tell you

3- Cigna may only cover it at a Cigna center of excellence for bariatrics. Vanderbilt may not be one. You can follow item 4

4- log onto/register at www.mycigna.com and check your own benefits.

Pm me if you need more assistance. I have Cigna

[Jersrose43 837]

Here is Cigna medical policy assuming it's not an employer exclusion.

https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

[Kindle 8,667]

My insurance doesn't cover WLS at all. In fact, there are absolutely no individual plans available in my state that include WLS. I found an incredible qualified and experienced surgeon at an International Center of Excellence and had my VSG in Mexico. A fraction of US cost, excellent care, painless, complication free recovery, and currently maintaining below goal 10 months later.

[JeannieBeannie 14]

Sorry for your struggles. A lot of folks have had success with the physicians in Mexico and costs about $5000...look into it. Theres even a support group on this site for people sleeved in Mexico.

Also, check your job and see when they'll have open enrollment. You may be able to switch to a carrier that does cover your insurance.

For all of you on Medicare, they have approved the surgery as of 2012...soon most insurance policy's will cover it,..just keep checking,..also it depends a lot on how your doctor writes it up...if you are a diabetic that is the one diagnosis that will do it for you.

[cc1967 25]

my insurance wouldn't cover the surgery.

@@effinmetal

sorry this happened to you

please don't throw the towel in yet

you can appeal their decision once, then i think twice

don't give up

thats what "they" are hoping you will do

that way ins doesn't have to pay

there are special forms you can get for a denial

start at your bariatric office/or doc/surgeon

"suzy orman " says borrowing from your 401K is a big no no Yes Suze would say it is a "no no " to borrow from retirement fund but better to borrow than take a hardware withdrawal (which is allowed fire non cosmetic medical procedures with most 401k's.).What point is a bigger 401k if you die from institute related issues? And I work in retirement finance so I know of what I speak.

i don't think a bank would give you a loan for surgery (could be wrong)

there are other borrowing situations like said

I don't know if there is a plan for paying surgery in Mexico (i kindof doubt it)

don't give up the ship yet - you hopefully won't drown

hope things work out

good luck

kathy

[Jersrose43 837]

I took a 401k withdrawal to consolidate debt. Tax guy was against it but turns out they don't recommend it because folks notoriously stop contributing to 401k while they pay off the debt.

I am paying the debt and jncreased 401 k contribution so see no issue

[loser2014 73]

I also took a withdrawal from my 401K. Figured there was no point in saving all that money for retirement if I wasn't going to be alive to spend it

I believe such a withdrawal is free of IRS penalty as it is used for medical expenses. But don't quote me on that.

[Natasha Estrada 36]

Honestly rather than being self pay considering that open enrollment is coming up you might want to purchase your own plan directly from the insurance company. Usually individual plans allow bariatric surgery. It's often that the employer based insurances that don't offer it.

I bought the best plan Blue Shield offers at $325 a month and it covers it so with the cost of premiums and about $2k in copayments coinsurance a year it works out to be about $6k total for everything the surgery the insurance and all my other medical expenses.

I was getting a worse deal getting it through my husbands company at $275 a month but my medications cost $60 more a month.

We have choices now so its nice.

[crystalsleeve 36]

I am 5 wks away from my surgery date and I'm still short 4900 for my surgery. My final payment is due 11/17. I'm very nervous. We are selling my husband's motorcycles to cover the cost, which was or plan. If they don't sell in time he said he would sell his truck. I'm freaking out a little. I have faith that the money will come it just may not be from where we envisioned it from.

[Jersrose43 837]

I also took a withdrawal from my 401K. Figured there was no point in saving all that money for retirement if I wasn't going to be alive to spend it

I believe such a withdrawal is free of IRS penalty as it is used for medical expenses. But don't quote me on that.

That's not exactly correct information

You should take a loan from 401k and pay yourself back not a withdrawal.

Withdrawal is subject to taxes unless it's a hardship qualifying case

In the case of medical expense you can withdraw funds for expenses PREVIOUSLY INCURRED to the

WithDrawl

Please read irs publication

See if you can borrow the amount you withdrew and then pay back the amount you withdrew

Any amount withdrawn your employer is required to hold 25% withholding tax as well I believe

http://www.irs.gov/Retirement-Plans/Plan-Sponsor/401(k)-Resource-Guide---Plan-Sponsors---General-Distribution-Rules