Self pay to insurance?

[jessa85 0]

Has anyone gone through the process self pay and then switched to insurance? I have been going through as self pay and I actually have a surgery date of March 12th. My husband is starting a new job and it looks like that insurance may actually cover the surgery! Has anyone ever made the switch mid way through the process? Looking for suggestions on how best to make sure that I make as smooth a transition as possible and don’t delay surgery any more then I need to!

[MourningTheLossOfBeer 42]

I haven't gone through that, but what I can tell you is that there are no roadblocks with self pay. Your insurance company may have you go through 3 to 6 months of nutritional visits first before they approve, or possibly other requirements.

[Khoric Ritter 20]

I agree with @MourningTheLossOfBeer . I would contact the insurance company and see what their process is for the gastric , or if they even cover it (I have BlueCross/BlueShield and while they offer gastric coverage, if the company (job) doesn't select it as an elective coverage for their plan, theres no coverage. Sadly thats how mine is. Company (job) doesn't want that added cost on all 300 employees, while only a handful of us want coverage for it. So they didn't select it as an elective. ).

If they do have the coverage, then it would be if you were okay with going through the hoops course they have and prolonging the operation a few months. If for some reason they do cover it and your semi okay with waiting, get with your doctors office, let them know whats happened, and see if they can contact the Insurance company. Hopefully then they may have lesser requirements / shorter time since you may have already had some of the things done.

The other things to note is deductibles and such. My friend had insurance coverage for it. Over 10 months worth of hoops, (her job required 10 months of crappppp) paying for doctors visits and all the co-pays for surgery, and all the bills she got afterwards, its cost her about $10k out of pocket over the last year. With what insurance hasn't or won't cover. While I just handed over 14$k worth of checks and have the comfort that I will not be billed for anything else. And don't have the hoops to go through.

Keep us updated on how it goes ❤️

[VIN_IN_AL 55]

I have gone from self-pay, tried to switch to insurance then back to self-pay. For me the attempted switch to insurance was a royal pain. BCBS, or at least my specific carrier provided coverage, but the requirements were to rigid. For example, I had already done 5 months with my current primary care physician in early 2019 for the “doctor supervised” diet. I exceeded all other requirements and already completed the psychiatric evaluation.

I got cold feet at the last minute and decided to attend a weight loss boot camp for 10 weeks as an attempt to avoid weight loss surgery. That was a BIG mistake, my doctor warned me I would gain the weight right back and that is exactly what happened by the end of 2019.

I decided to I move forward with surgery in 2020, was going to do self-pay at first since the weight loss boot camp was also self-payed. After going through my medical records for the last 3 years I felt I had enough documentation to use my employer provided health insurance so I immediately contacted BCBS for approval.

According to BCBS since I did not see my doctor during the time I was attending the weight loss boot camp (which was in another state), I would be required to restart the doctor supervised diet requirement which I was told back in Feb/2019 was three months but now, for whatever reason in 2/2020 it was increased to 6 months? 🤪

If I want BCBS to pick up the tab I must start over, that would be 7 months with the doctor since the first visit does not count, another 30 to 60 days for the approval process and 30 days with the surgeons office or more to get all pre-requisite tests completed and the surgery scheduled. VERY FRUSTRATING! I have appealed but was told it may be 30 to 60 days until I get a decision.

When I ask my doctor for advise he simply looked at me and said “I wouldn’t wait…” so I am not, back to self-pay.

Edited February 14, 2020 by VIN_IN_AL

[jessa85 0]

I have actually even as a self pay patient been going through the program since June of 2019 and my doctors office thinks that all of that will count as long as it’s covered by his individual employers plan. We will see today!

[jlb8080 45]

I went through insurance with zero hoops. Just a meeting with the surgeon, dietician, and a psych eval. All done in one day, was approved less than a week later. So def worth looking into. My deductible was only $500.