Health Insurance

[thestruggleof1 0]

My plan as well as any other plans ive looked into have these surguries as a plan exclusion. How have so many people gotten this approved? Where do you find the insurance? Are they all through employers? Feeling lost....

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[FrankyG 1,450]

There are many employer plans that do include it, and Medicaid also seems to cover it.

I had a specific exclusion on my insurance so I paid for mine out of pocket. Saved up and cut back on frivolous things.

Advantage is that there is no 6 month + waiting period or dealing with approvals. My insurance did cover part of the surgery since I had a hernia repair.

But that waiting period is also a good thing, as it gives a person time to get their mind wrapped around the changes they'll be having to make to get the most out of surgery (so it's not a wasted time period).

If you don't have enough to have it done in the U.S. (assuming that is where you live), then you should look into surgery in Mexico. It is significantly cheaper - I think under $6,000 or even lower - and you can do research on this forum. There should be a whole section dedicated to Mexico surgery options and recommendations, and the site has coordinators that can work with you to figure out the details.

Edited November 4, 2016 by FrankiesGirl

[hudjess 95]

I was approved because I did all of the requirements that the insurance wanted. I know its really hard to get approved and that's why I covered my butt a lot with going to extra dietitian appointments and doing whatever I can to assure that I would get approved. I did have to go through a lot of hurdles though. I was approved 3 days after it was sent to insurance with a surgery date of Nov. 21st.

[justhere4theshow 462]

Be sure your plan doesn't have a provision that states "Only when medically necessary". My plan shows weight loss surgery on the list of excluded services, but it has an exception for medical necessity. If your BMI is 40 or above, you should have no trouble claiming medical necessity. BMI of 35-40 also qualifies if you have a comorbidity like sleep apnea, high blood pressure, and a few others. It's worth looking into, just to be sure. Good luck to you!!

[Butterflywarrior 241]

I have blue shield and they cover most of it but you do have to have six months of nutrition counseling and stuff prior which they pay for. I have a ppo so I don't know if that makes a difference or not and I bought it through a broker.

I don't recall if there were particular requirements such as having a comorbidities etc

[thestruggleof1 0]

EVERYONE i know is getting these surgeries and ive been wanting it for about 4 years and cant.

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[Butterflywarrior 241]

EVERYONE i know is getting these surgeries and ive been wanting it for about 4 years and cant.

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maybe you need to talk to a social worker or insurance brokers perhaps for better guidance because even state medicaid pays for WLS these days!!

[MissJDVSG 129]

There are also medical loans you can take out to finance the surgery if you can't get it through insurance.

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[Aggiemae 739]

Our insurance covers it. They have requirement, including 6months of pre op classes and monthly medical checks. You can only go thru one clinic. There is a nutritionist, a physical therapist and a psychologist on staff. You can choose your surgeon.

Our insurance requires a psychological screening, and from some of the post I see here I think that all bariatric surgery candidates should be screened for mental health issues and eating disorders.

Post bariatric cosmetic surgery is excluded but more and more they are approving it in cases where there is skin breakdown or infection.