My insurance not paying for surgery

[Missytee 138]

I just received notice that my insurance is not paying for my surgery. I'm so depressed right now. My doctor told me that one of my test showed that I gave gallstones, so I hope he can do both at the same time and I just pay him. My doctor's office said the cost is 5000 for the doctor fee and 10,000 for the hospital. Now, I'm hoping that that the hospital fee can be charged for the gallstone surgery and not the sleeve. Keeping my fingers crossed.

[GassyGurl 428]

There are plenty of places who charge less if you're willing to travel. I'm going to Florida next week and it's$8899. I paid copays for preop testing, and a flat fee for the surgery and hospital. $400 for a hotel for hubby, gas money and that's all.

Don't discount Mexico either. Read reviews here and you'll be surprised. It costs as low as $4500, plus airfare to San Diego.

Sent from my XT1254 using BariatricPal mobile app

[Missytee 138]

Thanks for the advice. I just spoke to my doctor's insurance person and it looks like they can charge the hospital fee to my insurance for out of network. Now my doctor is charging 6,000 so it looks like it will be around 9,000

[JT2002TJ 170]

1 hour ago, Missytee said:

Thanks for the advice. I just spoke to my doctor's insurance person and it looks like they can charge the hospital fee to my insurance for out of network. Now my doctor is charging 6,000 so it looks like it will be around 9,000

Why did your insurance say they aren't paying? It seems from this forum that there are a percentage of people who are denied and still get insurance to pay via the appeals process.

I'm assuming that it isn't an exclusion, and you were denied after they sent the paperwork.

[Missytee 138]

Why did your insurance say they aren't paying? It seems from this forum that there are a percentage of people who are denied and still get insurance to pay via the appeals process.
I'm assuming that it isn't an exclusion, and you were denied after they sent the paperwork.

No my employer opted out of Bariatric surgery. We thought by law that they had to pay, but that's not the case. I work for a small company that is for profit and that's the way they do things....

[JT2002TJ 170]

15 hours ago, Missytee said:

No my employer opted out of Bariatric surgery. We thought by law that they had to pay, but that's not the case. I work for a small company that is for profit and that's the way they do things....

Yeah, I agree. It will almost be impossible to get coverage. As mentioned earlier in this thread, have you considered Mexico? They seem to do a good job, and most importantly have less hoops to jump through. You could probably have them do the gallbladder and WLS all for less than your $9k quote.

[Missytee 138]

I thought about it but I'm kind skeptical about going to another country. The time I pay for flight, hotel, and maybe a rental car I be payed the same-thing. I believe my doctor will come down some more on his price because he really want to help me...[emoji56][emoji56][emoji56]

[GassyGurl 428]

I thought about it but I'm kind skeptical about going to another country. The time I pay for flight, hotel, and maybe a rental car I be payed the same-thing. I believe my doctor will come down some more on his price because he really want to help me...[emoji56][emoji56][emoji56]

When you go to Mexico, you dont need a hotel or a rental car. They pick you up and drop you back off in San Diego. If you stay extra nights, its extra hotel fees, but normally a hotel is included for yourself and a companion for 2 - 4 days.

Sent from my XT1254 using BariatricPal mobile app

[Sosewsue61 3,185]

What state are you in?

[Missytee 138]

When you go to Mexico, you dont need a hotel or a rental car. They pick you up and drop you back off in San Diego. If you stay extra nights, its extra hotel fees, but normally a hotel is included for yourself and a companion for 2 - 4 days.

Sent from my XT1254 using BariatricPal mobile app

Cool....that's really nice. I had no idea. Thanks for the info .

[Natasha85 1]

Hey. I'm new here and I work for a small company as well so it's not covered. Right now I'm considering Mexico heavily. My only thing is my parents and friends are against it.

[Natasha85 1]

I would say consider Mexico as well. Using allegiant air, I plan on flying from Memphis to Los Angeles for under $100 then will rent a car to drive to San Diego. It's like a 2 hour drive but wayyyy cheaper!!

[Angie's_Ocean 213]

I was sceptical about Mexico too. In Canada WLS is covered by our health system (free), but there's a 2-7 year waiting period depending on how severe your case is. There's only 2 places in the entire country (!!!) that are private clinics (self-pay) and charge upwards of $20,000 Canadian (roughly $16,000 USD).
I did my research and frankly after all the excellent reviews I've read about Dr. Illan through BariatricPal MX I'm more than confident in his abilities. And they quoted me (as per their website) only $6100 USD. By no means am I advertising for them, just relaying what my plans are

[Natasha85 1]

Now I've ran into another issue. I can only remove a certain amount from my 401K and they stated that depending on the reason, it may not be approved. I don't understand why I can't remove what I need to get it done and why they're so many restrictions on it.

[JT2002TJ 170]

16 minutes ago, Natasha85 said:

Now I've ran into another issue. I can only remove a certain amount from my 401K and they stated that depending on the reason, it may not be approved. I don't understand why I can't remove what I need to get it done and why they're so many restrictions on it.

Did your company set the restriction? Because you should be able to remove as much as you want, it is just if you will be heavily fined by doing so. Do you have the option to take a loan against your 401K?