SHBP does not cover surgery

[mssonya84 4]

I am on my husband's BCBS Georgia insurance which is a State Health Benefit plan. I called and was told that they do not cover surgery. What are my other options?

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[Bufflehead 6,358]

First, I would make sure you get that in writing -- check your Member Benefit Guide and/or Plan Document. You would be surprised how much faulty information insurance reps give out.

If it really isn't covered, do you have access to other insurance that might cover it? For example, if you work, does your employment offer health insurance that covers bariatric surgery? If so, it might be worth your while to switch to that plan during your next open enrollment.

You can also explore self-pay options. If you are willing to travel, many people go to Mexico and have excellent experiences and I think options start around $4-5,000. If you aren't willing to go out of the country, there are self-pay options in the US starting around $12K I think. There is a whole sub-forum here for Mexico and Self-Pay options where you can probably get more info. Good luck!

[mssonya84 4]

Thanks. I don't work, I am a stay at home mom. Can I purchase an individual insurance plan that covers it?

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[Diana_in_Philly 1,426]

In all likelihood, an individual insurance plan that covers it would cost more in premiums than the surgery. Since your husband has insurance through work, you aren't eligible to try to buy through one of the Marketplaces. Do check all the written materials for the plan -- often it is covered but buried in the fine print. Many plans require one or two additional conditions in addition to BMI over 35 -- high blood pressure, diabetes, etc. Go to the website for the plan and check your plan documents.

[JamieLogical 8,710]

As others have said, you won't qualify for healthcare through the exchange, because your husband has employer provided coverage. That means you would have to purchase from an insurance company directly, which would cost a LOT of money.

Your best option is to try to get some financing to pay for the surgery yourself. I had mine in Mexico and just borrowed against my retirement account for the money. There are also some services that provide medical financing. You could look into home equity loans or personal loans as well.

[mssonya84 4]

On average, how much is the cost of the surgery

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[Read2016 658]

In NY I was quoted $18,000.... I have seen things online at websites like obesity action, think that's the right name that give information about what you might be able to do if you have an insurance that does not cover the surgery...

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[JamieLogical 8,710]

If you are willing to travel outside the country, BariatricPal is affiliated with a few surgeons in Mexico and they offer special package pricing to BariatricPal members. I think they are roughly in the $4500 range? If you contact one of the coordinators on the Self-Pay and Mexico forums, I am sure they could give you details.

[mssonya84 4]

Thanks everyone! !

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[KristenLe 5,979]

@@mssonya84 As others have said - don't take one person at BCBS word for it. Call and ask them for your coverage info. Alot of times the plan will say Weight Loss isn't covered but Bariatric Surgery is. Also ask for info from the benefits coordinator through your our husband's employer. Good luck!

[mssonya84 4]

His job said that I need to contact BCBS

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[Ele marie 92]

Here a lot of people

Have had it done on government aid. Free medical part of welfare. Some how seems very unfair.

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