Insurance Doesn't Cover Bariatric Surgery

[shortsoprano72 11]

My Insurance Company does not cover Bariatric Surgery. My PCP sent them a letter of Medical Necessity, as well as my Suergeon's Bariatric Coordinator reaching out to them. I need some tips on getting them to listen, or any other Insurance Companies, that cover Bariatric Surgery.

[2goldengirl 2,076]

If it isn't a benefit of your plan, it doesn't matter what kind of documentation your PCP or surgeon provides. A benefit exclusion means it isn't covered for anyone, in any case.

I have seen folks here who were found to have a hiatal hernia - insurance covered the hernia repair, they had to pay privately for the sleeve, but at least it's some coverage.

[shortsoprano72 11]

Thanks, 2GoldenGirl

Edited November 27, 2015 by shortsoprano72

[kdelrosso 124]

I work for an insurance company and unfortunately this isn't something that they will budge on. If you have insurance through your employer, the insurance company will sit down with the employer and go over what they do and what they don't want to cover. The insurance can't make an exception. I'm sorry to hear this is happening though. I always feel terrible when I get these calls while im working

[nikkimapr 177]

I had surgery through my employer insurance Cigna but my husband has state bcbs that doesn't cover for him to have surgery. We added him this year to my policy while keeping his state plan also so he could have surgery.

[shortsoprano72 11]

I'm gonna have my husband check with his Employer's Insurance. I have private Insurance.

[Kindle 8,667]

My insurance does not cover WLS in any way shape or form for any reason. Being self employed I have to get an individual policy and my state opted out of WLS coverage under the ACA. No option for me except self pay. Spent all my savings, that had been ear marked for a new truck (and a bit on a cc) and got it done anyways. Still drive a 17 year old rust bucket but have no buyers remorse. Best money ever spent.

[AvaFern 3,516]

My insurance also refused to cover WLS- I am also self-employed and pay for a private policy. 20K on sleeve surgery and 40k0ish on plastics, and while I could have bought a luxury car or a small house with that, it was more than worth it in the long run. I also used a credit card, then paid it off, so I could accumulate a whole ton of points in the process, haha.

[Yaberhoo 358]

My insurance doesn't cover bariatric surgery in any shape or form. I decided to do self pay in Mexico (way, way, way, way cheaper). I had my surgery on Oct 22, 2015 and had a fantastic experience.

[Tobeornottobe 89]

You should check this out really well, since your husband is still covered his insurance, his insurance would be primary and your insurance would be secondary. The general rule of thumb is they go by what the primary insurance covers. You should look into this before your husband starts the process.

Edited November 28, 2015 by Tobeornottobe

[Fat2Phat2016 541]

My insurance doesn't cover bariatric surgery in any shape or form. I decided to do self pay in Mexico (way, way, way, way cheaper). I had my surgery on Oct 22, 2015 and had a fantastic experience.

I too was turned down by my insurance and have decided to do the self pay Mexico route. My surgery is 12/07. Really excited. But when insurance wouldn't budge I had to do my research on all my options. I didn't give up without looking into everything. Mexico was the best for me. No matter what you do, GOOD LUCK!!

[LadyWarren 57]

I'm sorry to hear this. Open enrollment for Health insurance is going on right now. You may want to check into other insurance companies. And if you enroll by Dec 15, 2015, your coverage will start on January 1, 2016. The deadline to enroll is Jan 31, 2016. Good luck!

[shortsoprano72 11]

Thanks, LadyWarren!!!

I have been trying to find an Insurance that covers the surgery. I don't know if it's because of the state I live in or what.

[kdelrosso 124]

Thanks, LadyWarren!!!

I have been trying to find an Insurance that covers the surgery. I don't know if it's because of the state I live in or what.

Idk what state you're in but Cigna offers individual plans(private) through a bunch of states and they offer bariatric for their employees (I work for them) so I would assume they would have plans that cover it privately as well

[shortsoprano72 11]

Thanks, KDellRossa!!