I give up

[****505 girl 18]

Ahhh so my insurance just switched over to bibs of TX federal. I called today abs said my husband's employer has an exclusion to bariatric surgery !!!! I've been doing everything for 6 months all of my apts, Egd, Nutritional counseling, physic evaluation. Thousands of dollars out of pocket down the drain. What do I do now!!!!

[Shorty5 44]

I can understand your frustration! My insurance also didn't cover my surgery. I was so mad because even MEDICARE covers it. Plus, I was SAVING them money in the long run, drastically reduced risk of developing diabetes, possibly getting rid of my CPAP, less arthritis, etc. I am convinced that in a few years, insurance companies will be required to cover it.

But something had to be done, so I just paid for it out of pocket, took out a line of credit at the bank. Because I paid out of pocket for the surgery, I got in almost right away - they only required blood work, ECG, cardiac ultrasonography, EGD, (all of which my insurance DID pay for), which I got out of the way as quickly as I could. No 6-month diet, no psych eval required. I'll be paying on it for a long time, but it has been worth every penny.

Best of luck to you, please try to hang in there.

[onmywaytoonederland 236]

Ask your doctor to at least try to appeal this, stressing medical necessity. Do you have any co-morbidities that could help the appeal? High blood pressure, diabetes, sleep apnea, etc? Appealing can't hurt.

[imsoglad56 402]

@@onmywaytoonederland, there's nothing to appeal. It wasn't a decision to not cover it for her, the policy specifically excludes coverage.

[imsoglad56 402]

@@nmsugirl06, I notice you said it was bcbs of texas, so are you in Texas? My husband and I are, and our insurance covers WLS, but there are so many exclusions and special requirements that it might as well not. We ended up going to Dallas Bariatric Center, and had surgery with Dr. Nirmal Jayaseelan. We both had hiatal hernias so he billed our insurance for the hernia surgery and we paid out of pocket for him to do the sleeve at the same time. Total out of pocket was around $5,000 each. Not as good as it could have been with decent insurance, but MUCH better than the $18,000 each it would have cost us by using the bariatrics coverage that our insurance offers.

[****505 girl 18]

I'm actually in new Mexico about 30 min from El paso tx. I'm so frustrated. I called my Dr office and told them the situation they said self pay would be $13,500 and it doesn't even include the anesthesiologist! !! I do have a hiatal hernia found though the egd.

[onmywaytoonederland 236]

@@onmywaytoonederland, there's nothing to appeal. It wasn't a decision to not cover it for her, the policy specifically excludes coverage.

I'm very sorry. I meant request a medical exception. Especially if there are co-morbidities. A hiatal hernia may help with the exception.

[kyrickchick64 468]

Maybe since your close to Mexico maybe you can find a doctor there? It'll be less expensive than in the US

[kyrickchick64 468]

Keep harassing them. The squeaky wheel talk to everyone and get an appeal

[BLERDgirl 6,417]

Having the doctor bill for the hernia repair and you pay for the sleeve may be an option. $5k is about what it would cost to go to Mexico.

[****505 girl 18]

My dr. Doesn't give that option. He said either self pay or find different insurance. So I'm quickly trying to find a job with insurance or enough to cover for bcbs of new Mexico insurance

[kyrickchick64 468]

Ive heard that any of the obama care insurances will pay. Even tho your insurance says it's not covered you can appeal for medical necessities. You need some back up from your primary physician. So if you have high bp or diabetes or such talk to your dr.

[della street 213]

Hi there, re "Obamacare" -- depends on what state you're in. There are 23 states whose Affordable Care Act policies are required to cover WLS, of course w/diff out of pocket max, deductibles, etc. See this link - -- you may have to copy and paste the link, doesn't look like it's 'hot' --

http://www.bariatricpal.com/topic/282782-affordable-care-act/

I'm in AZ, and my ACA policy covers WLS, but it depends on where you live. It's the same with a number of other provisions for things like fertility treatments, autism coverage, and many more. States wanted control, so it varies by state.

Edited January 15, 2015 by della street

[****505 girl 18]

I'm on my husband's federal plan but it has exclusions for everything weightloss related. So I'm going to have him drop me and get bcbc of new Mexico. From what I understand NM is one of the 22 states to cover all weightloss but I'm a stay at home mom of a 2 year old so I'm scrambling trying to find a job to pay for this new insurance

[AWholeNewMama 34]

I'm on my husband's federal plan but it has exclusions for everything weightloss related. So I'm going to have him drop me and get bcbc of new Mexico. From what I understand NM is one of the 22 states to cover all weightloss but I'm a stay at home mom of a 2 year old so I'm scrambling trying to find a job to pay for this new insurance

Just a thought, but you may want to crunch the numbers here. You're a SAHM, so if you go back to work just to get a job to pay for this new insurance, you're going to have the expense of childcare, plus you'll be paying your copays OOP... I'm wondering if it might not be more cost-effective to consider paying OOP for surgery in Mexico.