magnificent2015 34 Posted October 19, 2015 I have about 150 pounds to lose ... I'm currently about 290-300lbs. I was denied by my insurance back in July due to not having been on a 12 month supervised diet ... That has to be cosigned monthly by my primary care. I currently have BCBS Charter Care in RI, but my insurance is actually located in North or South Carolina. I'm wondering if anyone has dropped their primary insurance to get Obamacare. Rhode Island is one of the states that does cover bariatric surgery. I'm assuming that they follow the 6 month nutritionist appointments (which I already have completed along with my EGD & psych eval. & sleep study). I would have continued but since those 6 months weren't validated by my primary care they are pretty much useless for my current insurance. Again, has anyone dropped their current insurance to get obamacare to get bariatric surgery covered? Share this post Link to post Share on other sites
OutsideMatchInside 10,166 Posted October 19, 2015 (edited) . Edited October 19, 2015 by OutsideMatchInside Share this post Link to post Share on other sites
refocus 6 Posted October 19, 2015 I live in VA. I had Anthem before the affordable care act...my policy at that time covered surgery. When ACA started my plan was no longer offered by Anthem...so I had to go to the open Market place. I currently have Anthem Health Keepers POS Gold. Guess what, called today and it doesn't cover the surgery. I'm so pissed off....I don't know if there is anything I can do at this point. If insurance doesn't cover can your doctor ask them to cover it due to medical reasons? I'm so irritated...I know that there are 22 states that have the ACA that do include the surgery...VA is just not one of them. Share this post Link to post Share on other sites
magnificent2015 34 Posted October 19, 2015 I live in VA. I had Anthem before the affordable care act...my policy at that time covered surgery. When ACA started my plan was no longer offered by Anthem...so I had to go to the open Market place. I currently have Anthem Health Keepers POS Gold. Guess what, called today and it doesn't cover the surgery. I'm so pissed off....I don't know if there is anything I can do at this point. If insurance doesn't cover can your doctor ask them to cover it due to medical reasons? I'm so irritated...I know that there are 22 states that have the ACA that do include the surgery...VA is just not one of them. I've honestly tried everything. This is my final resort. My insurance policy last year covered it, but the one this year didn't. Funny thing is my insurance is through the hospital where I would be having the surgery done. My insurance is through my father & he works at the hospital & with the surgeon who would be performing my surgery. They make this so difficult to get done. I know Medicaid & Medicare both cover, I'm not sure which one is which unfortunately. My surgeon tried to state the medical necessity due to back problems & being pre-diabetic, also that they say I have asthma due to my weight gain. It's so frustrating I started this whole process back in February. That's when I first attended the seminar. My entire process has been completed since June. Share this post Link to post Share on other sites
fromsleevedtome 50 Posted October 19, 2015 That is so frustrating! I went through a similar situation last year where my insurance covered the procedure, and I began the process. I got to the end of the 6 month diet and had completed all steps and my info was about to be submitted to insurance when my job switched insurance and the procedure was no longer covered. I was beyond bummed after getting that information and I just accepted the fact that I would need to save and put the surgery on the back burner. Fast forward a year and I decided to go to Mexico to have surgery. I had vsg surgery in June and it was the best decision I could have made. Stay positive and know that if you want it bad enough you will be able to find a way to make it work. Good luck! Share this post Link to post Share on other sites
magnificent2015 34 Posted October 20, 2015 That is so frustrating! I went through a similar situation last year where my insurance covered the procedure, and I began the process. I got to the end of the 6 month diet and had completed all steps and my info was about to be submitted to insurance when my job switched insurance and the procedure was no longer covered. I was beyond bummed after getting that information and I just accepted the fact that I would need to save and put the surgery on the back burner. Fast forward a year and I decided to go to Mexico to have surgery. I had vsg surgery in June and it was the best decision I could have made. Stay positive and know that if you want it bad enough you will be able to find a way to make it work. Good luck! I'm going to make sure that my current coverage doesn't make any adjustments to our policy for next year. I know my surgeon was trying to get our employer to cover it. I'm ensured by the same hospital that would be performing the surgery. So I will make sure that there isn't an change to our policy for next year. I would much rather stay covered under my dads plan, then have to actually go out & get my own Share this post Link to post Share on other sites
Proud2BMe 1,016 Posted October 20, 2015 Please keep in mind that Mexico is an option. It's self pay, around $4,500 plus air fare and some additional spending money. When you come back you can get follow up treatment by a doctor of your choice. So don't think it's hopeless. I had my surgery in Mexico. You also don't have to jump through the hoops that insurance companies make you do here in the states. Share this post Link to post Share on other sites
magnificent2015 34 Posted October 20, 2015 Please keep in mind that Mexico is an option. It's self pay, around $4,500 plus air fare and some additional spending money. When you come back you can get follow up treatment by a doctor of your choice. So don't think it's hopeless. I had my surgery in Mexico. You also don't have to jump through the hoops that insurance companies make you do here in the states. Going to Mexico isn't much of an option for me. I work part time, while in school full time. My insurance is currently through my fathers employer. One my parents wouldn't support me going to have the procedure done in Mexico at all, & since they would pretty much be the one funding it. That option is off the table. I considered it before & was shut down. Share this post Link to post Share on other sites
Cape Crooner 589 Posted October 20, 2015 Well I just hope you didn't vote for the liar... I think you can get it covered in Massachusetts, but that's Romneycare, not Obamacare... Share this post Link to post Share on other sites
AngelaWilliamsMD 290 Posted October 20, 2015 @@Cape Crooner, That's a completely unnecessary post. Share this post Link to post Share on other sites
Cape Crooner 589 Posted October 20, 2015 I guess, if we want to pretend elections have nothing to do with our healthcare options... Share this post Link to post Share on other sites
AngelaWilliamsMD 290 Posted October 20, 2015 Yes and I suppose if we had a Republican as President right now there'd be free weight loss surgery for everyone! Seriously though, the OP's question had nothing to do with you disrespecting the POTUS. Just calling you out on an immature remark. I'm going to move on now...you should too. Share this post Link to post Share on other sites
Cape Crooner 589 Posted October 21, 2015 I think facts in the OP and subsequent comments speak for themselves. Although I am not a republican, the fact is that wls is free in Massachusetts under a universal healthcare plan that was created by a republican. Enjoy your "move on"... Share this post Link to post Share on other sites
byebyedarkpassenger 203 Posted October 21, 2015 I'm in VA, have a plan through Obamacare, and it covers WLS. CareFirst PPO silver plan. I was really lucky that the plan didn't require a 6 month supervised diet and I was approved before I even knew the surgeon's office had submitted the paperwork to the insurance co. This is the first time I've had insurance that covers WLS and I'm grateful every day that treating my morbid obesity was made AFFORDABLE and ACCESSIBLE. Share this post Link to post Share on other sites
mommy319 31 Posted October 21, 2015 Check into Obamacare before you drop your current coverage. You may not qualify if you qualify under another plan. Share this post Link to post Share on other sites
