Denied now wanting to self pay

[Johnston7781@yahoo.com 12]

I was wondering if anyone else self paid? I was denied twice for my surgery. I have done all the pre op but everything stopped when tricare denied me. If you self paid with bypass what was your cost? Thank you!

[kell778 46]

Why were you denied, that's terrible!!!

[Johnston7781@yahoo.com 12]

They didn't say. My bmi is 38.6 but I have pre diabetes, lupus, severe arthritis, and my mom died at 52 from the samd things I have going on. But they said my arthritis was not bad enough.

I know I need to get healthy for my kiddos though

[HappytobMe 4]

I am in the same situation as you, considering self paying for this. I was rejected last week by insurance as well; just sent in an appeal. I have a BMI of 37, high blood pressure, high cholesterol, and severe GERD, and osteoarthritis in both knees. The insurance person called me and said with a BMI of 35 (where did that come from?!) and co-morbidities that weren't "imminently life-threatening" that they would not approve. As an example, they said someone had to be on 3 bp meds and still not have it be controlled...In my appeal I noted that most medical personnel would consider someone 100+ lbs overweight to be in a life-threatening condition, and that obesity is a serious disease with greatly increased risks for heart attack, stroke etc without any other warnings, and that my doctor considered this medically necessary for me. I will go the self pay route and finance it if I have too. I am in upstate NY so costs are especially high, and my doctor gave me a ballpark estimate of $25k. I have had Independent Health for years, and I am praying that the appeal will be approved, but not feeling very positive right now. I've done all the other pre-work, and am just ready to schedule surgery and start my new life!

[Knitchic 97]

My insurance excludes the bypass even though it is needed for extreme reflux and hernia issues. My surgeon has a bypass package for $25,000 which includes everything except dietician and psych evaluation. I hope to self pay and have surgery this fall.

[losing_the_band 133]

Before you self pay, contact a bariatric lawyer like the Lindstrom group. They'll do a free consultation with you, discuss whether they think you've got a good chance at getting you approved, and give you options. I finally got approved today after a few denials (had to do a peer-to-peer to get approved), but I had contacted them to be on the safe side because I was expecting to be denied again. If I was, I was planning on hiring them to help. And compared to paying for the surgery, it's not a lot of money.

[Johnston7781@yahoo.com 12]

Thanks yall! I have another appointment on the 10th of August. I have a hernia with severe reflux so that will be covered and I should only have to pay for the bypass. We will see if that works.

[HappytobMe 4]

I got denied a second time this week by my insurance. I was on a teleconference with 4 doctors paid by the insurance company to be there, and 3 insurance employees for a half hour. Just a little bit stacked against me, huh!? It was a sham. They said because I had had some success losing weight in the past (20 - 30 lbs) that I "hadn't exhausted all my weight loss options yet." The problem, as everyone here knows, is that if you starve for a bit on a drastic diet, of course you will lose some weight. But I've never come close to losing the weight I need to lose - not even half! I too have a hernia with severe reflux - never thought of asking insurance to cover part of that! I thought it was all or nothing. I'll call my insurance tomorrow. Anything to lower that bill will be helpful and reduce the personal loan we're going to take out for this.

[losing_the_band 133]

Seriously, before even contemplating self pay, contact a lawyer. The ones I mentioned in my last post have a really good approval rate, and their fee is very cheap compared to paying for surgery. They quoted me $600-650 for a basic appeal, or $900-950 for the works ($50 reduction if you pay in one payment). Add on $300 if you want it expedited. Compared to $15k-$25k, that's a really good deal.

At the very least, have your surgeon do a peer-to-peer appeal before giving up.

[BypassedLife 39]

I will be self-paying. My insurance does not cover anything! Ugh.

So cost of bypass is going to be $21,000 which includes everything.

I was able to get $8,000 loan from Care Credit which helps.

[Johnston7781@yahoo.com 12]

After a third attempt I will be having surgery on September 1st! Good luck and keep trying!

[Dub 9,922]

I"m getting estimates now.

First was $21,000 firm........second was ballpark $25,000.

[Knitchic 97]

$25,000

[cslove 141]

I am a self pay. My surgery will cost $11,800. My surgeon is Dr Matthew Weiner in MI.